Provider Demographics
NPI:1447479332
Name:COLLIER, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3627
Mailing Address - Country:US
Mailing Address - Phone:214-208-9883
Mailing Address - Fax:972-223-7688
Practice Address - Street 1:6351 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3627
Practice Address - Country:US
Practice Address - Phone:214-208-9883
Practice Address - Fax:972-223-7688
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0279208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040260403Medicaid
TX040260404Medicaid
TX040260405Medicaid
TX8J8513Medicare PIN
TX040260404Medicaid
TXG95528Medicare UPIN
TX040260405Medicaid
TX8L2910Medicare PIN
TX8J8515Medicare PIN
TX8J8516Medicare UPIN
TX8L3158Medicare PIN
TX8L2909Medicare PIN
TX8J8517Medicare PIN