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General NPI Number Information
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NPI Number | 1295925105
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Entity Type | Organization
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Legal Business Name | FRANK J COLLIE MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 08/19/2008
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Provider Practice Location Address
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Address Line | 148 CASA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1804
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Country | US
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Telephone | 805-543-8310
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Fax | 805-543-3754
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Provider Business Mailing Address
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Address Line | 148 CASA ST
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-1804
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Country | US
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Telephone | 805-543-8310
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Fax | 805-543-3754
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Authorized Official
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Title or Position | OWNER
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Name | FRANK J. COLLIE
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Credential | M.D.
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Telephone | 805-543-8310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Z11763
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License Number State | CA
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