Healthcare Provider Details

I. General information

NPI: 1669703161
Provider Name (Legal Business Name): WILLIAM COFFEY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: WILLIAM COFFEY R.N.

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 NORTHEAST LOOP 410 SUITE 120
SAN ANTONIO TX
78209-4282
US

IV. Provider business mailing address

2391 NORTHEAST LOOP 410
SAN ANTONIO TX
78209-4282
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-0152
  • Fax:
Mailing address:
  • Phone: 210-222-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number521683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: