Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 11303 | MO |
NPI | 1093774515 |
---|---|
Provider Name | Dr. Thomas Edward Coyle |
First Address | Columbia, MO 65203 |
Second Address | Columbia, MO 65203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 18/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T70911 | (02) |