Individual
LARRY L COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6250 OLD CANTON RD, SUITE 100, JACKSON, MS 39211-2946
(601) 957-1015
(601) 956-9721
Mailing address
1151 N STATE ST, SUITE 408, JACKSON, MS 39202-2407
(601) 957-1015
(601) 956-9721
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
09096
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00011793
—
MS
01
—
4405163
AETNA
MS
01
—
753068151003
TRICARE
MS
01
—
P00072975
RR MEDICARE
MS
Enumeration date
03/15/2006
Last updated
04/20/2008
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