Individual
DR. ENRIQUE COLLANTES STA. ANA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 HOSPITAL DR, HURRICANE, WV 25526-8712
(304) 757-8683
(304) 757-8684
Mailing address
2585 3RD AVE, HUNTINGTON, WV 25703-1642
(304) 697-1396
(304) 697-2086
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11628
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000416134
MSBCBS
WV
05
—
0056202000
—
WV
01
—
550641245
FEIN
WV
Enumeration date
08/20/2006
Last updated
05/29/2015
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