Healthcare Provider Details

I. General information

NPI: 1780265587
Provider Name (Legal Business Name): COLLIN JEFFREY LAPORTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SIERRA PARK RD
MAMMOTH LAKES CA
93546-2073
US

IV. Provider business mailing address

162 S MAIN ST
BISHOP CA
93514-3415
US

V. Phone/Fax

Practice location:
  • Phone: 760-924-4084
  • Fax:
Mailing address:
  • Phone: 406-529-5905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA207319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: