Basic Information
| Provider Information | |||||||||
| NPI: | 1568410934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22974 OVERSEAS HWY | ||||||||
| Address2: | |||||||||
| City: | CUDJOE KEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330424254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057457353 | ||||||||
| FaxNumber: | 3057457360 | ||||||||
| Practice Location | |||||||||
| Address1: | 8151 OVERSEAS HWY | ||||||||
| Address2: | |||||||||
| City: | MARATHON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330503200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057457353 | ||||||||
| FaxNumber: | 3057457360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 17715 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | ME95584 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 277479800 | 05 | FL | MEDICAID | P00445281 | 01 | FL | RAILROAD MEDICARE | OTHER | 93135 | 01 | FL | BC BS | OTHER |