Provider Demographics
NPI:1902076151
Name:COLLIN PHYSICAN SUPPORT
Entity Type:Organization
Organization Name:COLLIN PHYSICAN SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERRARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-612-8829
Mailing Address - Street 1:4001 W 15TH ST
Mailing Address - Street 2:#245
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5841
Mailing Address - Country:US
Mailing Address - Phone:972-612-8829
Mailing Address - Fax:972-612-2875
Practice Address - Street 1:4001 W 15TH ST
Practice Address - Street 2:#245
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5841
Practice Address - Country:US
Practice Address - Phone:972-612-8829
Practice Address - Fax:972-612-2875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty