Provider Demographics
NPI:1528847498
Name:COLLINS, DAVID SR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:COLLINS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-8306
Mailing Address - Country:US
Mailing Address - Phone:937-963-2037
Mailing Address - Fax:
Practice Address - Street 1:907 W 5TH ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-8306
Practice Address - Country:US
Practice Address - Phone:937-963-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003343175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist