Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 260570 | NY |
NPI | 1043465214 |
---|---|
Provider Name | Dr. Clyde Aulgin Collins |
First Address | Albany, NY 12208-3410 |
Second Address | Albany, NY 12208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 15/08/2012 |