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General NPI Number Information
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NPI Number | 1801035035
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Entity Type | Individual
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Provider Name | DWIGHT D COLLMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 07/12/2012
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Provider Practice Location Address
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Address Line | 6013 NW 32ND WAY
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City | BOCA RATON
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State | FL
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Zip | 33496-3364
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Country | US
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Telephone | 561-305-8163
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Fax |
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Provider Business Mailing Address
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Address Line | 6013 NW 32ND WAY
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City | BOCA RATON
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State | FL
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Zip | 33496-3364
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Country | US
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Telephone | 561-305-8163
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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 | 036-122526
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License Number State | IL
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