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General NPI Number Information
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NPI Number | 1104347426
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Entity Type | Individual
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Provider Name | DAVID JOHN THOR COLLINS MD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 450 EASTVOLD AVE
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City | ORTONVILLE
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State | MN
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Zip | 56278-1252
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Country | US
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Telephone | 320-487-4388
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Fax |
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Provider Business Mailing Address
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Address Line | 450 EASTVOLD AVE
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City | ORTONVILLE
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State | MN
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Zip | 56278-1252
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Country | US
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Telephone | 320-487-4388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2017022153
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 12225
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License Number State | SD
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 66943
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 12225
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License Number State | SD
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Taxonomy #5
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 66943
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License Number State | MN
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