Healthcare Provider Details

I. General information

NPI: 1568788735
Provider Name (Legal Business Name): REBECCA R COLLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA R JURRENS

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-2322
  • Fax:
Mailing address:
  • Phone: 979-218-5073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR3652
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberR3652
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: