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General NPI Number Information
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NPI Number | 1396297743
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Entity Type | Organization
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Legal Business Name | COASTAL PHYSICIANS REGIONAL, PLLC
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 3154 SE MILITARY DR STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78223-3975
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Country | US
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Telephone | 210-337-0911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6327
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-6327
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Country | US
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Telephone | 210-337-0911
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Fax |
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Authorized Official
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Title or Position | LLC BOARD MEMBER
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Name | DR. PAUL DAVID KENYON
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Credential | MD
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Telephone | 210-337-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 160288
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License Number State | TX
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