Basic Information
| Provider Information | |||||||||
| NPI: | 1851402572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Practice Location | |||||||||
| Address1: | 4037 TAYLOR RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574831403 | ||||||||
| FaxNumber: | 7574833757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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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 | 208800000X | 4834367-8905 | UT | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 0101034439 | VA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 107009004101 | 01 | UT | SELECT HEALTH PLANS | OTHER | 340020002 | 01 | UT | RAILROAD MEDICARE | OTHER | 19-00118 | 01 | UT | UNITED HEALTHCARE | OTHER | 48343671200001 | 01 | UT | REGENCE BC/BS | OTHER | QM0000054900 | 01 | UT | ALTIUS HEALTH PLANS | OTHER | 694887 | 01 | UT | DESERET MUTUAL HEALTHCARE | OTHER | 870673378COL | 01 | UT | EDUCATORS CARE | OTHER |