Healthcare Provider Details

I. General information

NPI: 1295123701
Provider Name (Legal Business Name): GEOFFREY COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LEEWARD RD
BELVEDERE CA
94920
US

IV. Provider business mailing address

14 LEEWARD RD
BELVEDERE CA
94920
US

V. Phone/Fax

Practice location:
  • Phone: 415-435-6308
  • Fax: 415-435-2243
Mailing address:
  • Phone: 415-435-6308
  • Fax: 415-435-2243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA25815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: