Provider Demographics
NPI:1588341747
Name:COLLAER, BENJAMIN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:WILLIAM
Last Name:COLLAER
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 1:101 BODIN CIRCLE
Mailing Address - Street 2:FAMILY MEDICINE RESIDENCY CLINIC
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:906-231-4553
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIRCLE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:94533
Practice Address - Country:US
Practice Address - Phone:906-231-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty