MEDICARE: JAMES C COGHLAN 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
1	207Q00000X	Family Medicine Physician	MD00018416	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080033432	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1922003896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C COGHLAN MD

Provider Business Mailing Address
First Line	:	1530 N 115TH ST
Second Line	:	STE 303
City	:	SEATTLE
State	:	WA
Zip	:	98133-8411
Country	:	US
Telephone Number	:	206-368-1933
Fax Number	:	206-368-1931

Provider Business Practice Location Address
First Line	:	1530 N 115TH ST
Second Line	:	STE 303
City	:	SEATTLE
State	:	WA
Zip	:	98133-8411
Country	:	US
Telephone Number	:	206-368-1933
Fax Number	:	206-368-1931

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/11/2008

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Directions to “ JAMES C COGHLAN MD” Practice Location

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