Provider Demographics
NPI:1568542256
Name:COASTAL ENT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:COASTAL ENT MEDICAL GROUP INC
Other - Org Name:COASTAL ENT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HALSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-458-1287
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 416
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1223
Mailing Address - Country:US
Mailing Address - Phone:858-457-1287
Mailing Address - Fax:858-452-9160
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 416
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1223
Practice Address - Country:US
Practice Address - Phone:858-457-1287
Practice Address - Fax:858-452-9160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30707207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty