Provider Demographics
NPI:1497734776
Name:COE, JOHN BEDFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BEDFORD
Last Name:COE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:BEDFORD
Other - Last Name:COE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8665 VENEZIA LN
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-2108
Mailing Address - Country:US
Mailing Address - Phone:405-562-3159
Mailing Address - Fax:405-562-3159
Practice Address - Street 1:8665 VENEZIA LN
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-2108
Practice Address - Country:US
Practice Address - Phone:405-562-3159
Practice Address - Fax:405-562-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036066573Medicaid
621730Medicare ID - Type Unspecified
IL036066573Medicaid