Provider Demographics
NPI:1063458255
Name:COIL, BRENT WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:WAYNE
Last Name:COIL
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 1:4230 HARDING PIKE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-297-6006
Mailing Address - Fax:615-222-1200
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 530
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-297-6006
Practice Address - Fax:615-222-1200
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044139A207Q00000X
TN50601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008800AMedicaid
000000206175OtherBLUE CROSS
TNP01290668OtherRR MEDICARE
TN6007890OtherBCBS
TNQ004110Medicaid
00000000982OtherMPLAN
IN185760JMedicare ID - Type Unspecified
TN1030I86505Medicare PIN
000000206175OtherBLUE CROSS