Healthcare Provider Details

I. General information

NPI: 1972745024
Provider Name (Legal Business Name): DAN A COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 E 10TH AVE SUITE 100
SALT LAKE CITY UT
84103-2853
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-7500
  • Fax:
Mailing address:
  • Phone: 801-408-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012-00510
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2012-00510
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number9388734-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: