Provider Demographics
NPI:1508952805
Name:DR DAVID COBURN M.D. PC
Entity Type:Organization
Organization Name:DR DAVID COBURN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. P.C.
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:COBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MC PC
Authorized Official - Phone:970-240-8822
Mailing Address - Street 1:835 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3916
Mailing Address - Country:US
Mailing Address - Phone:970-240-8822
Mailing Address - Fax:970-240-8823
Practice Address - Street 1:835 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3916
Practice Address - Country:US
Practice Address - Phone:970-240-8822
Practice Address - Fax:970-240-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17871207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020780Medicaid
A26046Medicare UPIN
CO04020780Medicaid