Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | C42368 | CA |
N | 207ND0900X | Dermatopathologist | C42368 | CA |
N | 207NS0135X | Procedural Dermatology | C42368 | CA |
NPI | 1437361771 |
---|---|
Provider Name | Dr. Paul Stephen Collins |
First Address | San Luis Obispo, CA 93405-1812 |
Second Address | San Luis Obispo, CA 93405-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B64985 | (02) | CA |