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General NPI Number Information
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NPI Number | 1043214661
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Entity Type | Individual
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Provider Name | DAVID BRYAN COUTIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 2126 SOLANO ST
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City | CORNING
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State | CA
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Zip | 96021
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Country | US
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Telephone | 530-824-4002
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Fax | 530-824-4084
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Provider Business Mailing Address
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Address Line | 19474 GREEN LAKES LOOP
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City | BEND
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State | OR
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Zip | 97702-1160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | G051871
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | GO51871
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | GO51871
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License Number State | CA
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