Provider Demographics
NPI:1427166487
Name:COLLIER, JEANINE SHANNON-ALLISON (MD)
Entity type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:SHANNON-ALLISON
Last Name:COLLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 LACLAIR ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2988
Mailing Address - Country:US
Mailing Address - Phone:541-266-6700
Mailing Address - Fax:541-888-8726
Practice Address - Street 1:281 LACLAIR ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2988
Practice Address - Country:US
Practice Address - Phone:541-266-6700
Practice Address - Fax:541-888-8726
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD213682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR138158Medicaid
OR138158Medicaid
G62262Medicare UPIN