Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 5136 | NC |
NPI | 1134117252 |
---|---|
Provider Name | Dr. Bobby Mcmanus Collins II |
First Address | Greenville, NC 27858-8432 |
Second Address | Greenville, NC 27834-5925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1638417 | (05) | PA |
U67065 | (02) | PA |