Individual
MR. ROGER RONALD COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T., C., L. A. T.
Contact information
Practice address
604 S RIO GRANDE AVE, AZTEC, NM 87410-2260
(505) 334-9616
(505) 334-7343
Mailing address
808 SPOTTED WOLF AVE, AZTEC, NM 87410-2093
(505) 334-5119
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
108
NM
Other
Enumeration date
11/28/2006
Last updated
07/08/2007
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