Healthcare Provider Details

I. General information

NPI: 1730154667
Provider Name (Legal Business Name): CLEVE BRANTLEY COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 MEDICAL DR STE 120
SAN ANTONIO TX
78229-5062
US

IV. Provider business mailing address

16620 N US HIGHWAY 281 STE 300
SAN ANTONIO TX
78232-2327
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-1515
  • Fax: 210-615-6904
Mailing address:
  • Phone: 210-614-1231
  • Fax: 210-616-0704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberF2608
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: