Provider Demographics
NPI:1497917173
Name:COILE, GARY WALLACE
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:WALLACE
Last Name:COILE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 MURDOCK DR STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-3257
Mailing Address - Country:US
Mailing Address - Phone:865-777-1212
Mailing Address - Fax:
Practice Address - Street 1:10710 MURDOCK DR STE 104
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-3257
Practice Address - Country:US
Practice Address - Phone:865-777-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000858332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies