Provider Demographics
NPI:1336104751
Name:COATS, JOHN MCRAE V (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MCRAE
Last Name:COATS
Suffix:V
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 7495 PRIMARY HEALTH SERVICES CENTER
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211
Mailing Address - Country:US
Mailing Address - Phone:318-388-1250
Mailing Address - Fax:318-388-0948
Practice Address - Street 1:2913 BETIN AVENUE PRIMARY HEALTH SERVICES CENTER
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-388-1250
Practice Address - Fax:318-388-0948
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2019-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA019519207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1381705Medicaid
B65645Medicare UPIN
LA1381705Medicaid