Provider Demographics
NPI:1366429383
Name:COLLINS, JAMES IVAN (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:IVAN
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1770 IOWA AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7401
Mailing Address - Country:US
Mailing Address - Phone:951-786-0801
Mailing Address - Fax:520-352-7610
Practice Address - Street 1:9522 E SAN SALVADOR
Practice Address - Street 2:#150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-767-2222
Practice Address - Fax:480-767-2289
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ248932085R0202X
DEC1-00256332085R0202X
TXJ82252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F80531Medicare UPIN
AZ80120Medicare ID - Type Unspecified
AZ80122Medicare ID - Type Unspecified