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General NPI Number Information
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NPI Number | 1194179168
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Entity Type | Individual
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Provider Name | TARYN BRADLEY COLLINS DO
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Gender | Male
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Dates
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Enumeration Date | 04/15/2016
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 1501 HILAND AVE
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City | BURLEY
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State | ID
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Zip | 83318-2688
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Country | US
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Telephone | 801-507-9700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 17706
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City | DENVER
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State | CO
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Zip | 80217-0706
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Country | US
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Telephone | 877-346-2211
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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 | 5315087447
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License Number State | MI
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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 | 2358
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | O-1896
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License Number State | ID
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