Provider Demographics
NPI:1114070422
Name:COYER, BRUCE H (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:H
Last Name:COYER
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 1:114 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2907
Mailing Address - Country:US
Mailing Address - Phone:859-276-4316
Mailing Address - Fax:859-277-1867
Practice Address - Street 1:114 PASADENA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2907
Practice Address - Country:US
Practice Address - Phone:859-276-4316
Practice Address - Fax:859-277-1867
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17480207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047202OtherBCBS KY
KY64174808Medicaid
KY64174808Medicaid
KY060016128Medicare PIN
KY1187501Medicare PIN