Provider Demographics
NPI:1104892074
Name:COLLINS, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:COLLINS
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 1:1201 W LA VETA AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4213
Mailing Address - Country:US
Mailing Address - Phone:714-639-3363
Mailing Address - Fax:714-532-3460
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-639-3363
Practice Address - Fax:714-532-3460
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33697207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0C3369700Medicaid
CA0C3369700Medicaid
CAA87670Medicare UPIN