Provider Demographics
NPI:1285697003
Name:COLLINS, EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
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 1:1333 WEST LOMBARD STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2193
Mailing Address - Country:US
Mailing Address - Phone:563-322-6666
Mailing Address - Fax:563-322-6844
Practice Address - Street 1:1333 WEST LOMBARD STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2193
Practice Address - Country:US
Practice Address - Phone:563-322-6666
Practice Address - Fax:563-322-6844
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21720207T00000X
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161323Medicaid
IL0091204066OtherBCBS
16132Medicare ID - Type Unspecified
IL0091204066OtherBCBS
A01429Medicare UPIN