Healthcare Provider Details

I. General information

NPI: 1477086767
Provider Name (Legal Business Name): DALE D COFFEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 PHYSICIANS DR
WILMINGTON NC
28401-7338
US

IV. Provider business mailing address

PO BOX 936857
ATLANTA GA
31193-6857
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0811
  • Fax: 910-343-5719
Mailing address:
  • Phone: 888-588-9680
  • Fax: 910-343-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2022-01613
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number227759
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: