Provider Demographics
NPI:1174942403
Name:COLLINS, JEFFREY W (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:COLLINS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6574 OAKMONT DR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-5958
Mailing Address - Country:US
Mailing Address - Phone:707-579-4239
Mailing Address - Fax:707-579-0459
Practice Address - Street 1:6574 OAKMONT DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-5958
Practice Address - Country:US
Practice Address - Phone:707-579-4239
Practice Address - Fax:707-579-0459
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13861207N00000X
CA19114207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology