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General NPI Number Information
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NPI Number | 1255680674
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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 | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 4800 N E STALLINGS DRIVE SUITE 111
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1250
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Country | US
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Telephone | 936-564-7383
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Fax | 936-569-0549
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Provider Business Mailing Address
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Address Line | 4800 N E STALLINGS DRIVE SUITE 111
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1250
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Country | US
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Telephone | 936-564-7383
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Fax | 936-569-0549
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Authorized Official
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Title or Position | OWNER
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Name | DR. DENNIS W COFFMAN
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Credential | M.D.
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | EO423
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License Number State | TX
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