Provider Demographics
NPI:1407986979
Name:COYNE, BRIAN KIP (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KIP
Last Name:COYNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N HEMMER RD # 110
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9690
Mailing Address - Country:US
Mailing Address - Phone:907-746-5678
Mailing Address - Fax:
Practice Address - Street 1:1901 N HEMMER RD # 110
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9690
Practice Address - Country:US
Practice Address - Phone:907-746-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3355213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPD11483Medicaid
AKPD1148Medicaid
AKPD11481Medicaid
AKPD11482Medicaid
AKPD11482Medicaid
AKPD1148Medicaid
AKPD11483Medicaid