Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G30774 | CA |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G30774 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | M3906 | ID |
NPI | 1023010824 |
---|---|
Provider Name | Dr. Michael J Coughlin |
First Address | Meridian, ID 83642-1026 |
Second Address | San Francisco, CA 94143-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 15/05/2018 |