Provider Demographics
NPI:1124070495
Name:COLLINS, GEOFFREY JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:JAMES
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 1:250 BEGLIS PKWY 1
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-3503
Mailing Address - Country:US
Mailing Address - Phone:337-905-7100
Mailing Address - Fax:337-905-7101
Practice Address - Street 1:250 BEGLIS PKWY 1
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-3503
Practice Address - Country:US
Practice Address - Phone:337-905-7100
Practice Address - Fax:337-905-7101
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09996R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACI9478OtherRR MEDICARE GROUP LEGACY
LA5U305D847OtherMEDICARE LEGACY NUMBER
LA09996ROtherSTATE LICENSE NO.
LAP00134321OtherRR MEDICARE #
LA1986062Medicaid
LAF77550Medicare UPIN
LA09996ROtherSTATE LICENSE NO.
LACI9478OtherRR MEDICARE GROUP LEGACY
LAP00776299Medicare PIN