Healthcare Provider Details

I. General information

NPI: 1326080920
Provider Name (Legal Business Name): JOHN G COLLINS ND PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 NE WEIDLER STREET
PORTLAND OR
97232
US

IV. Provider business mailing address

2907 NE WEIDLER STREET
PORTLAND OR
97232
US

V. Phone/Fax

Practice location:
  • Phone: 503-493-9155
  • Fax: 503-493-1578
Mailing address:
  • Phone: 503-493-9155
  • Fax: 503-493-1578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0446
License Number StateOR

VIII. Authorized Official

Name: DR. JOHN GREGORY COLLINS
Title or Position: PRESIDENT
Credential: ND
Phone: 503-493-9155