Provider Demographics
NPI:1679778591
Name:COLLINS, ROBERT EDWARD JR (CO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:COLLINS
Suffix:JR
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1142 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6439
Mailing Address - Country:US
Mailing Address - Phone:910-350-0067
Mailing Address - Fax:910-350-0065
Practice Address - Street 1:1142 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-350-0067
Practice Address - Fax:910-350-0065
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist