Provider Demographics
NPI:1548481781
Name:COLLINS, HENRY LEE (CSA)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:LEE
Last Name:COLLINS
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:PO BOX 1733
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76101-1733
Mailing Address - Country:US
Mailing Address - Phone:817-455-1680
Mailing Address - Fax:817-346-9151
Practice Address - Street 1:2713 CLOVERMEADOW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2107
Practice Address - Country:US
Practice Address - Phone:817-346-9151
Practice Address - Fax:817-346-9151
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX02164363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical