Provider Demographics
NPI:1043214661
Name:COUTIN, DAVID BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRYAN
Last Name:COUTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19474 GREEN LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2126 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021
Practice Address - Country:US
Practice Address - Phone:530-824-4002
Practice Address - Fax:530-824-4084
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG051871207K00000X
CAGO51871208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA93120Medicare UPIN
ORR0000BLBTTMedicare ID - Type Unspecified