Healthcare Provider Details

I. General information

NPI: 1124123419
Provider Name (Legal Business Name): DEBORAH L COATES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 PATTERSON RD
DAYTON OH
45420-1522
US

IV. Provider business mailing address

1074 PATTERSON RD
DAYTON OH
45420-1522
US

V. Phone/Fax

Practice location:
  • Phone: 937-254-3988
  • Fax: 937-254-1005
Mailing address:
  • Phone: 937-254-3988
  • Fax: 937-254-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number34003893
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number34.003893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: