Provider Demographics
NPI:1437193679
Name:COFFEY, RANDALL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:CRAIG
Last Name:COFFEY
Suffix:
Gender:M
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:PO BOX 1687
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1687
Mailing Address - Country:US
Mailing Address - Phone:970-243-3300
Mailing Address - Fax:970-243-4464
Practice Address - Street 1:607 28 1/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-6023
Practice Address - Country:US
Practice Address - Phone:970-243-3300
Practice Address - Fax:970-243-4464
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23765207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ717340Medicaid
H79540Medicare UPIN
8EZ22RMedicare ID - Type Unspecified