Healthcare Provider Details

I. General information

NPI: 1891022430
Provider Name (Legal Business Name): MICHAEL WAYNE COGGINS RPA, RRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 SW 20TH PL #100
OCALA FL
34471-7881
US

IV. Provider business mailing address

5494 SW 83RD ST
OCALA FL
34476-3754
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-1212
  • Fax: 352-237-0066
Mailing address:
  • Phone: 352-208-1174
  • Fax: 866-259-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: