Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A73812 | CA |
N | 207VE0102X | Reproductive Endocrinologist | A73812 | CA |
NPI | 1205870482 |
---|---|
Provider Name | Dr. Mickey Semo Coffler |
First Address | San Diego, CA 92103-8201 |
Second Address | San Diego, CA 92103-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A738120 | (05) | CA |
H09397 | (02) |