MEDICARE: DR. DENNIS L COLLEGE M.D.

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
1	207RP1001X	Pulmonary Disease Physician	ME30562	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110010623	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	62379	OTHER	FL	BC/BS
2	4045574	OTHER	FL	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285630806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS L COLLEGE M.D.

Provider Business Mailing Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	STE C
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-3366
Fax Number	:	727-442-8171

Provider Business Practice Location Address
First Line	:	1305 S FORT HARRISON AVE
Second Line	:	STE C
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3301
Country	:	US
Telephone Number	:	727-441-3366
Fax Number	:	727-442-8171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/29/2010

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