Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A25815 | CA |
NPI | 1295123701 |
---|---|
Provider Name | Dr. Geoffrey Collins |
First Address | Belvedere, CA 94920 |
Second Address | Belvedere, CA 94920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 06/01/2015 |