Healthcare Provider Details

I. General information

NPI: 1487674875
Provider Name (Legal Business Name): DAVID A COBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E 3RD ST
DELTA CO
81416-2815
US

IV. Provider business mailing address

PO BOX 10100
DELTA CO
81416-0008
US

V. Phone/Fax

Practice location:
  • Phone: 970-874-2417
  • Fax: 970-874-6491
Mailing address:
  • Phone: 970-874-2470
  • Fax: 970-874-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17871
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: