Healthcare Provider Details

I. General information

NPI: 1740392612
Provider Name (Legal Business Name): TERRYL RAND COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

100 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax: 606-439-6629
Mailing address:
  • Phone: 606-439-1331
  • Fax: 606-439-6629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number39865
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: