Healthcare Provider Details

I. General information

NPI: 1932288644
Provider Name (Legal Business Name): MARK ANDREW COATES P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 TEXAN TRL SUITE 300
CORPUS CHRISTI TX
78411-2549
US

IV. Provider business mailing address

1660 S STAPLES ST STE 150
CORPUS CHRISTI TX
78404-3156
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-0811
  • Fax: 361-806-5040
Mailing address:
  • Phone: 361-654-2064
  • Fax: 361-654-2068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04556
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: