Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | G051871 | CA |
N | 208000000X | Pediatrician | GO51871 | CA |
Y | 208D00000X | General Practice Physician | GO51871 | CA |
NPI | 1043214661 |
---|---|
Provider Name | Dr. David Bryan Coutin |
First Address | Bend, OR 97702-1160 |
Second Address | Corning, CA 96021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93120 | (02) | OR |