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NPI Code Detail

MEDICARE: DR. JARED COFFMAN MD

MEDICARE: DR. JARED COFFMAN 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
1207L00000XAnesthesiology Physician01065791AIN
2208VP0014XInterventional Pain Medicine Physician01065791AIN

General Provider Information

NPI Number : 1053579151
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JARED COFFMAN MD
Provider Business Mailing Address
First Line : 1721 MAGNAVOX WAY
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1537
Country : US
Telephone Number : 260-748-3650
Fax Number :
Provider Business Practice Location Address
First Line : 1721 MAGNAVOX WAY
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-1537
Country : US
Telephone Number : 260-748-3650
Fax Number : 260-569-2305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2008
Last Update Date : 07/28/2022

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Directions to “ DR. JARED COFFMAN MD” Practice Location

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