Provider Demographics
NPI:1104883339
Name:COLLINS, RONNIE THOMAS II (MD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:THOMAS
Last Name:COLLINS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:T
Other - Last Name:COLLINS
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:750 WELCH RD STE 321
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1510
Mailing Address - Country:US
Mailing Address - Phone:650-723-7913
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE L203
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1510
Practice Address - Country:US
Practice Address - Phone:859-323-6754
Practice Address - Fax:859-323-3499
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP086207RA0002X, 2080P0202X
CAC147103208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43425Medicare UPIN
5AD94Medicare PIN
5AD94Medicare PIN