Provider Demographics
NPI:1316058340
Name:COLLIER, STEPHEN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:COLLIER
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:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-423-8697
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:29 N STAR DR
Practice Address - Street 2:SUTE C
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6656
Practice Address - Country:US
Practice Address - Phone:731-664-7949
Practice Address - Fax:731-664-6141
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827835Medicaid
TN38278351Medicare PIN
G71329Medicare UPIN
TN3827835Medicaid