Provider Demographics
NPI:1730186958
Name:COLLINS, SHARON A (M D)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:A
Last Name:COLLINS
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 10TH ST SE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2442
Mailing Address - Country:US
Mailing Address - Phone:319-363-3600
Mailing Address - Fax:319-363-9971
Practice Address - Street 1:411 10TH ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2442
Practice Address - Country:US
Practice Address - Phone:319-363-3600
Practice Address - Fax:319-363-9971
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
IA26978208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA182329OtherWELLMARK BLUE CROSS BL S
IA1053173Medicaid
IAB68881Medicare UPIN