Provider Demographics
NPI:1033141510
Name:JOHN P. COUGHLIN M.D. P.A.
Entity Type:Organization
Organization Name:JOHN P. COUGHLIN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:813-631-5034
Mailing Address - Street 1:12220 BRUCE B DOWNS BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-9201
Mailing Address - Country:US
Mailing Address - Phone:813-631-5034
Mailing Address - Fax:813-631-5061
Practice Address - Street 1:12220 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9201
Practice Address - Country:US
Practice Address - Phone:813-631-5034
Practice Address - Fax:813-631-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME677202086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMEDICARE/B99138Medicare UPIN
B99138Medicare ID - Type Unspecified