Healthcare Provider Details

I. General information

NPI: 1174525836
Provider Name (Legal Business Name): WILLIAM MARTIN COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

IV. Provider business mailing address

109 E MAIN ST
WHITESBURG KY
41858-7351
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4488
  • Fax: 606-633-8383
Mailing address:
  • Phone: 606-633-4488
  • Fax: 606-633-8383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23375
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: