Healthcare Provider Details

I. General information

NPI: 1245496926
Provider Name (Legal Business Name): LINDA COFFEY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19222 STONEHUE SUITE 103
SAN ANTONIO TX
78258-3453
US

IV. Provider business mailing address

19222 STONEHUE SUITE 103
SAN ANTONIO TX
78258-3453
US

V. Phone/Fax

Practice location:
  • Phone: 210-497-1475
  • Fax: 210-497-1502
Mailing address:
  • Phone: 210-497-1475
  • Fax: 210-497-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG4925
License Number StateTX

VIII. Authorized Official

Name: DR. LINDA JEAN ROYALL COFFEY
Title or Position: MD
Credential: M.D.
Phone: 210-497-1475