Healthcare Provider Details

I. General information

NPI: 1265439582
Provider Name (Legal Business Name): JOHN BERNARD COLL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 S BRADFORD ST
DOVER DE
19904-4141
US

IV. Provider business mailing address

1095 S BRADFORD ST
DOVER DE
19904-4141
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-8100
  • Fax:
Mailing address:
  • Phone: 302-678-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberC20003201
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC20003201
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: