Healthcare Provider Details

I. General information

NPI: 1750077525
Provider Name (Legal Business Name): COLLIN DAGUE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E SIOUX AVE
PIERRE SD
57501-3323
US

IV. Provider business mailing address

801 E SIOUX AVE
PIERRE SD
57501-3323
US

V. Phone/Fax

Practice location:
  • Phone: 605-295-8543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18845
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: