Individual
GREGORY COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6810 STATE ROUTE 162, STE 215, MARYVILLE, IL 62062-8501
(618) 288-5711
Mailing address
1836 LACKLAND HILL PKWY, CREDENTIALING DEPARTMENT, SAINT LOUIS, MO 63146-3572
(314) 989-0300
(314) 810-1399
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036079652
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079652002
—
IL
Enumeration date
11/10/2006
Last updated
02/19/2008
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