Provider Demographics
NPI:1255315669
Name:COFFMAN, HEATHER MARIE STOY (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE STOY
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 N FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-0951
Mailing Address - Country:US
Mailing Address - Phone:916-893-3112
Mailing Address - Fax:
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:STE 107
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-772-2222
Practice Address - Fax:928-733-2598
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR50318174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1255315669OtherAETNA
AZ1255315669OtherUHC
AZ1255315669OtherHMN
AZ1255315669OtherBCBS
AZ1255315669OtherAFMC
AZ042328Medicaid
AZ1255315669OtherCIGNA
AZ1255315669OtherHEALTH NET
AZ1255315669OtherAETNA