Healthcare Provider Details

I. General information

NPI: 1043220874
Provider Name (Legal Business Name): WARREN PATRICK COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 E PRIMROSE ST SUITE B
SPRINGFIELD MO
65804-4279
US

IV. Provider business mailing address

1342 E PRIMROSE ST SUITE B
SPRINGFIELD MO
65804-4279
US

V. Phone/Fax

Practice location:
  • Phone: 417-869-3200
  • Fax: 417-869-3212
Mailing address:
  • Phone: 417-869-3200
  • Fax: 417-869-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number114662
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: