Provider Demographics
NPI:1437199684
Name:COATES, JOHN T (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:COATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:640 S WINTERGARDEN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3544
Mailing Address - Country:US
Mailing Address - Phone:419-353-7069
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:209 BRIAR HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-9504
Practice Address - Country:US
Practice Address - Phone:419-257-1417
Practice Address - Fax:419-257-7408
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34007620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274686Medicaid
OHDA5101OtherRR MEDICARE
OH2274686Medicaid
OHH53999Medicare UPIN