Provider Demographics
NPI:1558671032
Name:COYLE DEMOSS, DPM,PA
Entity Type:Organization
Organization Name:COYLE DEMOSS, DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMOSS,DPM,PA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:903-463-1000
Mailing Address - Street 1:1001 N EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2340
Mailing Address - Country:US
Mailing Address - Phone:903-463-1000
Mailing Address - Fax:903-463-7711
Practice Address - Street 1:1001 N EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2340
Practice Address - Country:US
Practice Address - Phone:903-463-1000
Practice Address - Fax:903-463-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0499213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088311801Medicaid
TX0937580001Medicare NSC
TXT12956Medicare UPIN