Healthcare Provider Details

I. General information

NPI: 1740244672
Provider Name (Legal Business Name): GREGORY JAMES COLLINS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

4820 DARBY RD
AVON NY
14414-9634
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number207049
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: