Healthcare Provider Details

I. General information

NPI: 1386629772
Provider Name (Legal Business Name): COLLINS FISHER RADIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HWY 59 BYPASS
WHARTON TX
77488
US

IV. Provider business mailing address

PO BOX 421209
HOUSTON TX
77242-1209
US

V. Phone/Fax

Practice location:
  • Phone: 713-481-3533
  • Fax: 713-432-0221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. O. PRESTON COPELAND
Title or Position: OWNER
Credential: M.D.
Phone: 713-481-3533