Healthcare Provider Details

I. General information

NPI: 1417361973
Provider Name (Legal Business Name): WILLIAM MICHAEL COLLINS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 COWELL BLVD
DAVIS CA
95618-6325
US

IV. Provider business mailing address

1955 COWELL BLVD
DAVIS CA
95618-6325
US

V. Phone/Fax

Practice location:
  • Phone: 530-757-7100
  • Fax:
Mailing address:
  • Phone: 530-757-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A15413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: