Individual
MITCHELL ALLEN COLLAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 885-6111
Mailing address
254 BAKER ST APT 4, MOSCOW, ID 83843-3276
(208) 503-2493
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
ID
Other
Enumeration date
07/22/2019
Last updated
07/22/2019
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