Provider Demographics
NPI:1083696520
Name:COE, ALAN JASON (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JASON
Last Name:COE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5046 COFLER LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2900
Mailing Address - Country:US
Mailing Address - Phone:310-601-4437
Mailing Address - Fax:818-505-3814
Practice Address - Street 1:116 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 805
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3103
Practice Address - Country:US
Practice Address - Phone:310-601-4437
Practice Address - Fax:818-505-3814
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0141432084P0800X
MS142372084P0800X
CAC534882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1302759Medicaid
LA5K066Medicare ID - Type Unspecified
B60710Medicare UPIN