Provider Demographics
NPI:1093417040
Name:COFFMAN, SAM
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7A CALLE VISON
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-7112
Mailing Address - Country:US
Mailing Address - Phone:575-224-2233
Mailing Address - Fax:
Practice Address - Street 1:7A CALLE VISON
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7112
Practice Address - Country:US
Practice Address - Phone:575-224-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No171100000XOther Service ProvidersAcupuncturist