Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7365 | OK |
NPI | 1003433582 |
---|---|
Provider Name | Dr. Matthew Brice Collier |
First Address | Durant, OK 74701-3094 |
Second Address | Durant, OK 74701-3094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2020 |
Last Update Date | 22/09/2021 |