Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35070748 | OH |
Y | 207X00000X | Orthopaedic Surgeon | G72913 | CA |
NPI | 1023047438 |
---|---|
Provider Name | Michael J Coen |
First Address | San Bernardino, CA 92423-0069 |
Second Address | Highland, CA 92346-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 09/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G729130 | (05) | CA |
0257823 | (05) | OH |
G36638 | (02) |