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General NPI Number Information
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NPI Number | 1912990227
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Entity Type | Individual
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Provider Name | JOHN W. COLLINS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 02/10/2019
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Provider Practice Location Address
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Address Line | 19550 E 39TH ST S SUITE 400
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2303
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Country | US
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Telephone | 816-254-4800
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Fax | 816-254-4641
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Provider Business Mailing Address
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Address Line | 3709 S BOLGER CT
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City | INDEPENDENCE
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State | MO
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Zip | 64055-3971
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Country | US
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Telephone | 816-254-4800
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Fax | 816-254-4641
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | R3688
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License Number State | MO
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