Provider Demographics
NPI:1124522560
Name:COLLIN, JOHN DAVID (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:COLLIN
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2054 RIVERSIDE AVENUE
Mailing Address - Street 2:APT 4302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204
Mailing Address - Country:US
Mailing Address - Phone:904-613-7499
Mailing Address - Fax:904-244-8054
Practice Address - Street 1:653-1 WEST 8TH STREET
Practice Address - Street 2:2ND FLOOR LRC
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-2000
Practice Address - Fax:904-244-8054
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN27676390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program