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NPI Code Detail

MEDICARE: DR. KENNETH PAUL COFFEY M.D.

MEDICARE: DR. KENNETH PAUL COFFEY M.D.
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
1174400000XSpecialist10847OK
22085R0202XDiagnostic Radiology Physician10847OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300034744OTHEROKRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679571582
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH PAUL COFFEY M.D.
Provider Business Mailing Address
First Line : 4500 S GARNETT RD
Second Line : STE 919
City : TULSA
State : OK
Zip : 74146-5214
Country : US
Telephone Number : 405-364-7900
Fax Number : 405-366-6214
Provider Business Practice Location Address
First Line : 825 E ROBINSON ST
Second Line :
City : NORMAN
State : OK
Zip : 73071-6610
Country : US
Telephone Number : 405-364-7900
Fax Number : 405-366-6214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 01/02/2019

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