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General NPI Number Information
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NPI Number | 1215089818
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Entity Type | Organization
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Legal Business Name | DENNIS W COFFMAN M D
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 06/16/2009
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Provider Practice Location Address
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Address Line | 4800 NE STALLINGS SUITE 112
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-564-7033
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Fax | 936-564-7909
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Provider Business Mailing Address
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Address Line | 4800 NE STALLINGS SUITE 112
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City | NACOGDOCHES
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State | TX
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Zip | 75965
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Country | US
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Telephone | 936-564-7033
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Fax | 936-564-7909
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Authorized Official
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Title or Position | OWNER MEDICAL DIRECTOR
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Name | DENNIS W COFFMAN
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Credential |
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Telephone | 936-564-7383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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