Provider Demographics
NPI:1962407072
Name:COLLINS, DAVID DUTROW (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:DUTROW
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:3333 BROOKVIEW HILLS BLVD
Practice Address - Street 2:STE 207
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5661
Practice Address - Country:US
Practice Address - Phone:336-765-5250
Practice Address - Fax:336-659-0953
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27145207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900496Medicaid
NCP00391425OtherRR MEDICARE
NC27145OtherMEDICAL LICENSE
NC205528DMedicare PIN
C83304Medicare UPIN