MEDICARE: MARK E. COIRA, P.C.

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	261QM2500X	Medical Specialty Clinic/Center	4216	TX

General Provider Information

NPI Number	:	1649557984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK E. COIRA, P.C.

Provider Business Mailing Address
First Line	:	8014 KITTY HAWK
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	210-658-6000
Fax Number	:	210-658-6843

Provider Business Practice Location Address
First Line	:	8014 KITTY HAWK
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-2424
Country	:	US
Telephone Number	:	210-658-6000
Fax Number	:	210-658-6843

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK EMIL COIRA
Credential	:	D.C.
Telephone Number	:	210-658-6000

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	02/28/2012

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