Provider Demographics
NPI:1104074137
Name:DARRYL DEWITT COLLINS, M.D.,P.A.
Entity type:Organization
Organization Name:DARRYL DEWITT COLLINS, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-777-2886
Mailing Address - Street 1:213 CEDAR DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2921
Mailing Address - Country:US
Mailing Address - Phone:361-777-2886
Mailing Address - Fax:361-777-3667
Practice Address - Street 1:213 CEDAR DR
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2921
Practice Address - Country:US
Practice Address - Phone:361-777-2886
Practice Address - Fax:361-777-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00329RMedicare PIN