Healthcare Provider Details

I. General information

NPI: 1245890375
Provider Name (Legal Business Name): JOHN EVIS CODA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 05/08/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

IV. Provider business mailing address

350 PARRISH ST
CANANDAIGUA NY
14424-1731
US

V. Phone/Fax

Practice location:
  • Phone: 585-396-6129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351044758
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number321871
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301507074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: