Provider Demographics
NPI:1982602504
Name:COLLINS, ROBERT S (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:COLLINS
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 1:980 HIGHWAY 28
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3695
Mailing Address - Country:US
Mailing Address - Phone:423-942-2851
Mailing Address - Fax:423-942-3049
Practice Address - Street 1:980 HIGHWAY 28
Practice Address - Street 2:STE 102
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3695
Practice Address - Country:US
Practice Address - Phone:423-942-2851
Practice Address - Fax:423-942-3049
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 16256207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3840679Medicaid
TN4081720OtherBLUE CROSS BLUE SHIELD
TN4232629OtherBLUECROSSBLUESHIELD
TN38406791OtherMEDICARE TYPE UNSPECIFIED
A97919Medicare UPIN
TN3840679Medicaid