Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 00017069 | AL |
Y | 111NI0900X | Internist | 00017069 | AL |
NPI | 1003802885 |
---|---|
Provider Name | Damian Joseph Collins |
First Address | Mobile, AL 36604-1407 |
Second Address | Mobile, AL 36604-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 27/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000086601 | (05) | AL |
F49351 | (02) |