Provider Demographics
NPI:1245286905
Name:COLLINS, GARY B (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:COLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 GREENLEY RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5200
Mailing Address - Country:US
Mailing Address - Phone:209-536-5000
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST.-MS 11502V
Practice Address - Street 2:HEALTHPARTNERS REGIONS SPECIALTY CLINICS
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4870
Practice Address - Fax:651-254-4870
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI66130-20208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245286905Medicaid
MN1701441OtherMEDICA
MNHP53803OtherHEALTHPARTNERS
MN135399D417OtherUCARE
FM171P7COOtherBLUE CROSS BLUE SHIELD
MN684417100Medicaid
MN020002134Medicare ID - Type Unspecified
MN34660600OtherWISCONSIN MA