Healthcare Provider Details

I. General information

NPI: 1275626962
Provider Name (Legal Business Name): GRIFFIN RAY COATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15920 S RANCHO SAHUARITA BLVD STE 150
SAHUARITA AZ
85629-8014
US

IV. Provider business mailing address

2262 E PAGE MILL DR
GREEN VALLEY AZ
85614
US

V. Phone/Fax

Practice location:
  • Phone: 423-260-4323
  • Fax:
Mailing address:
  • Phone: 423-260-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number32349
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: