Basic Information
| Provider Information | |||||||||
| NPI: | 1811953730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLLIER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376194231 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MCKINLEY PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433026399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403838728 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35083497 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000362613 | 01 | OH | BCBS FOR BUCYRUS | OTHER | P00217253 | 01 | OH | RR MEDICARE # BUCYRUS | OTHER | 000000384658 | 01 | OH | BCBS FOR GALION | OTHER | 2557120 | 05 | OH | MEDICAID | 000000545410 | 01 | OH | BCBS MARION | OTHER | P00121199 | 01 | OH | RR MEDICARE FOR MARION | OTHER |