Provider Demographics
NPI:1467612259
Name:COATS, ELLEN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:COATS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:ELIZABETH
Other - Last Name:PETERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8990 NAVARRE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-2216
Mailing Address - Country:US
Mailing Address - Phone:850-396-0108
Mailing Address - Fax:850-939-4933
Practice Address - Street 1:8990 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2216
Practice Address - Country:US
Practice Address - Phone:850-396-0108
Practice Address - Fax:850-939-4933
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120695207R00000X
VA0101248091208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14Y3DOtherBCBSFL
FL013909900Medicaid
FL013909900Medicaid