Basic Information
| Provider Information | |||||||||
| NPI: | 1801188248 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLINS | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 W 3RD ST | ||||||||
| Address2: | GREAT PLAINS REGIONAL MEDICAL CENTER | ||||||||
| City: | ELK CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 736445145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802252511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1705 E 19TH ST | ||||||||
| Address2: | STE 302 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741045405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187487585 | ||||||||
| FaxNumber: | 9187487539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5035 | OK | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.