Healthcare Provider Details

I. General information

NPI: 1124056726
Provider Name (Legal Business Name): ALAN JOSEPH KOFFRON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 E 3RD ST STE 200
CHATTANOOGA TN
37404-2624
US

IV. Provider business mailing address

979 E 3RD ST STE 300
CHATTANOOGA TN
37403-2187
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-0466
  • Fax:
Mailing address:
  • Phone: 423-267-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61833
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036090432
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number61833
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: