Healthcare Provider Details

I. General information

NPI: 1265616296
Provider Name (Legal Business Name): PHILLIP OLIVER COFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

2789 25TH ST STE 3
SAN FRANCISCO CA
94110-3583
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA119921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: