Healthcare Provider Details

I. General information

NPI: 1679682512
Provider Name (Legal Business Name): JAMES J COYLE, MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S WOODS MILL RD STE 35
CHESTERFIELD MO
63017-3662
US

IV. Provider business mailing address

226 S WOODS MILL RD STE 35W
CHESTERFIELD MO
63017-3442
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-6860
  • Fax: 314-944-0373
Mailing address:
  • Phone: 314-994-0313
  • Fax: 314-994-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number117979
License Number StateMO

VIII. Authorized Official

Name: HEATHER CLARK
Title or Position: ACCTS MANAGER
Credential:
Phone: 314-994-0313