Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME67720 | FL |
NPI | 1548292915 |
---|---|
Provider Name | Mr. John Patrick Coughlin |
First Address | Tampa, FL 33612-9201 |
Second Address | Tampa, FL 33612-9201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264225500 | (05) | FL |