Provider Demographics
NPI:1386647816
Name:COATS, LAURICE P (MD)
Entity Type:Individual
Prefix:
First Name:LAURICE
Middle Name:P
Last Name:COATS
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 1:1050 N SAN FRANCISCO ST
Mailing Address - Street 2:STE F
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3259
Mailing Address - Country:US
Mailing Address - Phone:928-213-9180
Mailing Address - Fax:
Practice Address - Street 1:1050 N SAN FRANCISCO ST
Practice Address - Street 2:STE F
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3259
Practice Address - Country:US
Practice Address - Phone:928-213-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53098Medicare UPIN
AZMD22463Medicare PIN