MEDICARE: DR. JOHN MICHAEL COFFEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G37339	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003826728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MICHAEL COFFEY MD

Provider Business Mailing Address
First Line	:	107 N HALL ST
Second Line	:	STE D
City	:	VISALIA
State	:	CA
Zip	:	93291-5850
Country	:	US
Telephone Number	:	559-733-4775
Fax Number	:	559-733-1783

Provider Business Practice Location Address
First Line	:	107 N HALL ST
Second Line	:	STE D
City	:	VISALIA
State	:	CA
Zip	:	93291-5850
Country	:	US
Telephone Number	:	559-733-4775
Fax Number	:	559-733-1783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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