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NPI Code Detail

MEDICARE: JON COLLIER MD

MEDICARE: JON COLLIER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianC4699AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134179195
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON COLLIER MD
Provider Business Mailing Address
First Line : PO BOX 1179
Second Line :
City : MOUNTAIN HOME
State : AR
Zip : 72654-1179
Country : US
Telephone Number : 870-424-7070
Fax Number : 870-424-6616
Provider Business Practice Location Address
First Line : 900 W KINGSHIGHWAY
Second Line :
City : PARAGOULD
State : AR
Zip : 72450-5942
Country : US
Telephone Number : 870-424-7070
Fax Number : 870-424-6616
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 09/13/2010

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