Healthcare Provider Details

I. General information

NPI: 1164335279
Provider Name (Legal Business Name): WILLIAM LEE COLLINS FA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

3851 HERITAGE LN
KINGMAN AZ
86409-0519
US

V. Phone/Fax

Practice location:
  • Phone: 928-747-2101
  • Fax:
Mailing address:
  • Phone: 850-693-0161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5532
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: