Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0028942 | FL |
NPI | 1003855255 |
---|---|
Provider Name | Alan Steven Collin |
First Address | Port St Lucie, FL 34952-7585 |
Second Address | Port St Lucie, FL 34952-7585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 17/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0028942 | FLORIDA LICENSE NUMBER (01) | FL |
039319300 | (05) | FL |
1003855255 | NPI (01) | |
830003201 | RAILROAD MEDICARE (01) | FL |
92812 | BLUE CROSS BLUE SHIELD (01) | FL |
D79545 | (02) | FL |