Basic Information
| Provider Information | |||||||||
| NPI: | 1891157806 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST CLAIR | ||||||||
| FirstName: | COLLIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3099 HELMSDALE PL | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405092213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592586401 | ||||||||
| FaxNumber: | 8592586438 | ||||||||
| Practice Location | |||||||||
| Address1: | 3099 HELMSDALE PL | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405092213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592586401 | ||||||||
| FaxNumber: | 8592586438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2016 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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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 | 207Q00000X | 04582 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.