Individual
SAMUEL L COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
203 S WESTERN AVE, TONASKET, WA 98855-8803
(509) 486-3144
Mailing address
1510 E BROADWAY, MOUNT VERNON, WA 98274-4523
(541) 231-2591
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
PA00601
OR
363AS0400X
Surgical Physician Assistant
PA60475541
WA
363AS0400X
Surgical Physician Assistant
PA9103177
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2037524
—
WA
05
—
292272000
—
FL
Enumeration date
11/07/2006
Last updated
08/23/2021
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