Provider Demographics
NPI:1568667749
Name:COUGHLIN, SHAUN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TURTLE ROCK CT
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1300
Mailing Address - Country:US
Mailing Address - Phone:415-435-5803
Mailing Address - Fax:
Practice Address - Street 1:2 TURTLE ROCK CT
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1300
Practice Address - Country:US
Practice Address - Phone:415-435-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52403207RC0000X
MA52746207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease