Healthcare Provider Details

I. General information

NPI: 1114070422
Provider Name (Legal Business Name): BRUCE H COYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PASADENA DR
LEXINGTON KY
40503-2907
US

IV. Provider business mailing address

114 PASADENA DR
LEXINGTON KY
40503-2907
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-4316
  • Fax: 859-277-1867
Mailing address:
  • Phone: 859-276-4316
  • Fax: 859-277-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number17480
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: