Healthcare Provider Details

I. General information

NPI: 1235391566
Provider Name (Legal Business Name): RAMONA N COFFIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 ROGERSVILLE RD
RADCLIFF KY
40160-9344
US

IV. Provider business mailing address

PO BOX 2309
ELIZABETHTOWN KY
42702-2309
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-1150
  • Fax: 270-352-5658
Mailing address:
  • Phone: 270-706-1111
  • Fax: 270-706-1682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTP130
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: