=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912193491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANK R COLLIER JR M D P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2007
-----------------------------------------------------
Last Update Date | 03/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6859 BELFORT OAKS PL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-296-2229
-----------------------------------------------------
Fax | 904-296-3082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6859 BELFORT OAKS PL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32216-6242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-296-2229
-----------------------------------------------------
Fax | 904-296-3082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | FRANK R COLLIER JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 904-296-2229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 69991
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------