Healthcare Provider Details

I. General information

NPI: 1437272705
Provider Name (Legal Business Name): BRYAN NEIL COFFING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 W ALASKA DR STE 250
LAKEWOOD CO
80226-3328
US

IV. Provider business mailing address

3926 SIMMS CT
WHEAT RIDGE CO
80033-3875
US

V. Phone/Fax

Practice location:
  • Phone: 303-592-7284
  • Fax: 303-892-0601
Mailing address:
  • Phone: 908-447-0785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301085982
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number50216
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: