Provider Demographics
NPI:1003826728
Name:COFFEY, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:COFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:107 N HALL ST
Mailing Address - Street 2:STE D
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-5850
Mailing Address - Country:US
Mailing Address - Phone:559-733-4775
Mailing Address - Fax:559-733-1783
Practice Address - Street 1:107 N HALL ST
Practice Address - Street 2:STE D
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5850
Practice Address - Country:US
Practice Address - Phone:559-733-4775
Practice Address - Fax:559-733-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG37339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G373390Medicaid
CAA47045Medicare UPIN
CA00G373390Medicaid