Healthcare Provider Details

I. General information

NPI: 1396476628
Provider Name (Legal Business Name): BRODIE GARRISON COLLINS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 MURRIETA HOT SPRINGS RD STE D130
MURRIETA CA
92563-9110
US

IV. Provider business mailing address

PO BOX 34869
BELFAST ME
04915-0626
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-4611
  • Fax:
Mailing address:
  • Phone: 858-450-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberT18-2022
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6124
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: