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NPI Code Detail

MEDICARE: DR. EDWIN L. COFFMAN M.D.

MEDICARE: DR. EDWIN L. COFFMAN 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
1207L00000XAnesthesiology PhysicianC2686AR
2208D00000XGeneral Practice PhysicianC2686AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
351096OTHERARARKANSAS BCBS

General Provider Information

NPI Number : 1366440380
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWIN L. COFFMAN M.D.
Provider Business Mailing Address
First Line : PO BOX 1824
Second Line :
City : FORT SMITH
State : AR
Zip : 72902-1824
Country : US
Telephone Number : 479-709-7399
Fax Number : 479-709-7053
Provider Business Practice Location Address
First Line : 1001 TOWSON AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72901-4921
Country : US
Telephone Number : 479-441-5362
Fax Number : 479-441-4868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 10/02/2008

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