Provider Demographics
NPI:1114979879
Name:COATS, GERALD O (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:O
Last Name:COATS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13101 N ORACLE RD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9554
Mailing Address - Country:US
Mailing Address - Phone:520-818-5490
Mailing Address - Fax:520-818-5488
Practice Address - Street 1:13101 N ORACLE RD
Practice Address - Street 2:SUITE 157
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9554
Practice Address - Country:US
Practice Address - Phone:520-818-5490
Practice Address - Fax:520-818-5488
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ33718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ980757Medicaid
AZ980757Medicaid