Provider Demographics
NPI:1558459347
Name:COATES, STEVE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:COATES
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SE 18TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-622-3360
Mailing Address - Fax:352-671-3269
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-622-3360
Practice Address - Fax:352-671-3269
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101763363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL970030726OtherRR MEDICARE PROVIDER NUMB
FL291927300Medicaid
FLPA9101763OtherP.A.LICENSE NUMBER
FL1050992OtherP.A.CERTIFICATE NUMBER
FL291927300Medicaid