Individual
MR. GAYLORD COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
2495 SHREVEPORT HWY, BLD 2 RM 242, PINEVILLE, LA 71306-9004
(318) 473-0010
(318) 483-5154
Mailing address
2114 SHREVEPORT HWY, APT 275, PINEVILLE, LA 71360-2006
(601) 842-7780
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
CP003397
—
Other
Enumeration date
11/03/2008
Last updated
11/03/2008
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