Individual
DR. R. MICHAEL COLLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2730 E SUNSHINE ST, SPRINGFIELD, MO 65804-2047
(417) 883-0600
(417) 883-9443
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R7D68
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202014536
—
MO
01
—
83025
AR BLUE SHIELD #
MO
Enumeration date
02/13/2007
Last updated
07/22/2008
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