Provider Demographics
NPI:1073930020
Name:COYNOR, SETH JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:JAMES
Last Name:COYNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1937
Mailing Address - Country:US
Mailing Address - Phone:812-547-9661
Mailing Address - Fax:812-547-0281
Practice Address - Street 1:148 13TH ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1937
Practice Address - Country:US
Practice Address - Phone:812-547-9661
Practice Address - Fax:812-547-0281
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10549594-1204208000000X
IN02006188208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300045238Medicaid
KY7100712600Medicaid