MEDICARE: JAMIE P COFFEY DPM

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	265	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1133950002	OTHER	AZ	MEDICARE NSC

General Provider Information

NPI Number	:	1801894654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE P COFFEY DPM

Provider Business Mailing Address
First Line	:	PO BOX 793
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85299-0793
Country	:	US
Telephone Number	:	480-892-3180
Fax Number	:	480-892-1891

Provider Business Practice Location Address
First Line	:	2451 E BASELINE RD
Second Line	:	STE. C-230
City	:	GILBERT
State	:	AZ
Zip	:	85234-2471
Country	:	US
Telephone Number	:	480-892-3180
Fax Number	:	480-892-1891

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	12/09/2010

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Directions to “ JAMIE P COFFEY DPM” Practice Location

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