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General NPI Number Information
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NPI Number | 1750871844
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Entity Type | Individual
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Provider Name | RYAN COFFEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | BLDG 5-4257, BASTOGNE ST
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City | FORT BRAGG
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State | NC
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Zip | 28310-2102
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Country | US
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Telephone | 910-908-9187
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 BOZEMAN LOOP APT 29
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-5689
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Country | US
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Telephone | 401-473-9535
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2022-00292
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License Number State | NC
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