Healthcare Provider Details

I. General information

NPI: 1437199684
Provider Name (Legal Business Name): JOHN T COATES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BRIAR HILL RD SUITE A
NORTH BALTIMORE OH
45872-9504
US

IV. Provider business mailing address

640 S WINTERGARDEN RD SUITE B
BOWLING GREEN OH
43402-3544
US

V. Phone/Fax

Practice location:
  • Phone: 419-257-1417
  • Fax: 419-257-7408
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007620
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: