Healthcare Provider Details

I. General information

NPI: 1831131309
Provider Name (Legal Business Name): KARL ROBERT COULTER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 30TH ST SUITE A
OAKLAND CA
94609-3301
US

IV. Provider business mailing address

419 30TH ST SUITE A
OAKLAND CA
94609-3301
US

V. Phone/Fax

Practice location:
  • Phone: 510-832-1818
  • Fax: 510-832-1818
Mailing address:
  • Phone: 510-832-1818
  • Fax: 510-832-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: