MEDICARE: DR. KEVIN EMERSON COATES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD426809	PA
2	207X00000X	Orthopaedic Surgery Physician	0101243787	VA
3	207X00000X	Orthopaedic Surgery Physician	MD049632	TN
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	2011-01365	NC
5	207X00000X	Orthopaedic Surgery Physician	2011-01365	NC

General Provider Information

NPI Number	:	1235129487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN EMERSON COATES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 602658
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2658
Country	:	US
Telephone Number	:	336-716-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 MILLER ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2508
Country	:	US
Telephone Number	:	336-716-8093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/19/2016

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