Provider Demographics
NPI:1306190913
Name:COFFMAN, ROBERT L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 N BUTTERFIELD RD STE C1
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3017
Mailing Address - Country:US
Mailing Address - Phone:417-327-3530
Mailing Address - Fax:417-327-3543
Practice Address - Street 1:1245 N BUTTERFIELD RD STE C1
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3017
Practice Address - Country:US
Practice Address - Phone:417-327-3530
Practice Address - Fax:417-327-3543
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019045868103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist