Healthcare Provider Details

I. General information

NPI: 1013904838
Provider Name (Legal Business Name): RONALD L COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 SAINT JULIAN PL
COLUMBIA SC
29204-2409
US

IV. Provider business mailing address

1711 SAINT JULIAN PL
COLUMBIA SC
29204-2409
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-0911
  • Fax: 803-256-2480
Mailing address:
  • Phone: 803-779-0911
  • Fax: 803-256-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number8598
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: