Individual
DEAN STANLEY COLLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
315 E BROADWAY, STE 250, LOUISVILLE, KY 40202-3700
(502) 589-4765
(502) 589-4799
Mailing address
315 E BROADWAY, STE 250, LOUISVILLE, KY 40202-3700
(502) 589-4765
(502) 589-4799
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
32071
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065792
ANTHEM
—
01
—
0007332133
AETNA
—
05
—
1103006
—
KY
05
—
20232790A
—
IN
05
—
64320716
—
KY
Enumeration date
08/02/2006
Last updated
06/12/2008
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