Individual
MARK JEROME COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5940 E COPPER HILL DR, SUITE B, PRESCOTT VALLEY, AZ 86314-2860
(702) 379-2227
Mailing address
5940 E COPPER HILL DR, SUITE B, PRESCOTT VALLEY, AZ 86314-2860
(702) 379-2227
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
20A12037
CA
2084P0804X
Child & Adolescent Psychiatry Physician
02847
IA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
4145
AZ
2084P0804X
Child & Adolescent Psychiatry Physician
766
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002019797
—
NV
01
—
W-416
MEDICARE PTAN
CA
Enumeration date
08/13/2006
Last updated
05/25/2016
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