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General NPI Number Information
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NPI Number | 1245286905
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Entity Type | Individual
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Provider Name | GARY B COLLINS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 12/28/2024
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Provider Practice Location Address
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Address Line | 640 JACKSON ST.-MS 11502V HEALTHPARTNERS REGIONS SPECIALTY CLINICS
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City | ST. PAUL
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State | MN
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Zip | 55101-2502
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Country | US
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Telephone | 651-254-4870
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Fax | 651-254-4870
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Provider Business Mailing Address
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Address Line | 1000 GREENLEY RD
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City | SONORA
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State | CA
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Zip | 95370-5200
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Country | US
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Telephone | 209-536-5000
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 66130-20
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License Number State | WI
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