MEDICARE: DR. PAUL DOUGLAS COFFIN D.P.M.

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	213E00000X	Podiatrist	362	IA
2	213E00000X	Podiatrist	275	NE
3	213E00000X	Podiatrist	99	SD

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	:	1336133966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL DOUGLAS COFFIN D.P.M.

Provider Business Mailing Address
First Line	:	3450 S LAKEPORT ST
Second Line	:	SUITE B
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4509
Country	:	US
Telephone Number	:	712-255-5048
Fax Number	:	712-255-5263

Provider Business Practice Location Address
First Line	:	3450 S LAKEPORT ST
Second Line	:	SUITE B
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-4509
Country	:	US
Telephone Number	:	712-255-5048
Fax Number	:	712-255-5263

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	11/19/2007

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Directions to “ DR. PAUL DOUGLAS COFFIN D.P.M.” Practice Location

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