Healthcare Provider Details

I. General information

NPI: 1962407072
Provider Name (Legal Business Name): DAVID DUTROW COLLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROOKVIEW HILLS BLVD STE 207
WINSTON-SALEM NC
27103-5661
US

IV. Provider business mailing address

1701 WESTCHESTER DR STE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-5250
  • Fax: 336-659-0953
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number27145
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27145
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: