Provider Demographics
NPI:1366559700
Name:COLLINS, DONALD M (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:M
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LUCERNE TERRACE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-843-4251
Mailing Address - Fax:407-843-6461
Practice Address - Street 1:1109 LUCERNE TERRACE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-843-4251
Practice Address - Fax:407-843-6461
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01654OtherBLUE CROSS
FL7635287OtherAETNA PPO POS
H45442Medicare UPIN
FL01654ZMedicare PIN