Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G37339 | CA |
NPI | 1003826728 |
---|---|
Provider Name | Dr. John Michael Coffey |
First Address | Visalia, CA 93291-5850 |
Second Address | Visalia, CA 93291-5850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G373390 | (05) | CA |
A47045 | (02) | CA |