Provider Demographics
NPI:1992772487
Name:COLLINS, TERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
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 1:24710 ELLESMERE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1368
Mailing Address - Country:US
Mailing Address - Phone:210-614-5316
Mailing Address - Fax:210-614-5316
Practice Address - Street 1:24710 ELLESMERE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1368
Practice Address - Country:US
Practice Address - Phone:210-614-5316
Practice Address - Fax:210-614-5316
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE35422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116856904Medicaid
TX116856905Medicaid
C14661Medicare UPIN
8D8075Medicare ID - Type UnspecifiedSTRIC MEDICARE
TXP00251779Medicare PIN
TX116856904Medicaid