Individual
DR. ROGER C COLLICOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MEADOW DR, DANVILLE, IN 46122-1414
(317) 718-0970
(317) 718-0973
Mailing address
100 MEADOW DR, DANVILLE, IN 46122-1414
(317) 718-0970
(317) 718-0973
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01033269A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100134020A
—
IN
Enumeration date
04/10/2006
Last updated
06/16/2008
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