Basic Information
| Provider Information | |||||||||
| NPI: | 1922286277 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | EDGAR | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COLLINS | ||||||||
| OtherFirstName: | EDGAR | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | II | ||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3466 N 2575 W | ||||||||
| Address2: | |||||||||
| City: | FARR WEST | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844048611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017316577 | ||||||||
| FaxNumber: | 8017318089 | ||||||||
| Practice Location | |||||||||
| Address1: | 747 E SAINT GEORGE BLVD | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847703035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356736111 | ||||||||
| FaxNumber: | 4356731510 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 02/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 134387-1205 | UT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.