MEDICARE: JOHN T COATES DO

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	34007620	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA5101	OTHER	OH	RR MEDICARE

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	:	1437199684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN T COATES DO

Provider Business Mailing Address
First Line	:	640 S WINTERGARDEN RD
Second Line	:	SUITE B
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-3544
Country	:	US
Telephone Number	:	419-353-7069
Fax Number	:	419-353-7076

Provider Business Practice Location Address
First Line	:	209 BRIAR HILL RD
Second Line	:	SUITE A
City	:	NORTH BALTIMORE
State	:	OH
Zip	:	45872-9504
Country	:	US
Telephone Number	:	419-257-1417
Fax Number	:	419-257-7408

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/03/2016

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Directions to “ JOHN T COATES DO” Practice Location

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