Healthcare Provider Details

I. General information

NPI: 1932424660
Provider Name (Legal Business Name): ANDREW DANIEL COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SETTLERS TRACE BLVD
LAFAYETTE LA
70508-6060
US

IV. Provider business mailing address

320 SETTLERS TRACE BLVD
LAFAYETTE LA
70508-6060
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-9495
  • Fax: 337-981-7451
Mailing address:
  • Phone: 337-981-9495
  • Fax: 337-981-7451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number2015-00868
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number303260
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: