Provider Demographics
NPI:1457306334
Name:COYNE, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:COYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-5218
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:18785 BROOKHURST ST STE 200
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7300
Practice Address - Country:US
Practice Address - Phone:714-378-5330
Practice Address - Fax:714-378-5320
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00621279OtherMEDICARE RAILROAD
CAWA71497BMedicare PIN
CAH20461Medicare UPIN