=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679057392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLIN COUNTY DOCTORS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2018
-----------------------------------------------------
Last Update Date | 06/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4760 PRESTON RD STE 244-305
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-8548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-413-1146
-----------------------------------------------------
Fax | 972-428-3629
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4760 PRESTON RD STE 244-305
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034-8548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-413-1146
-----------------------------------------------------
Fax | 972-428-3629
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | JUAN ANTONIO CONTRERAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 409-789-2866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------