Provider Demographics
NPI:1609927979
Name:COFFEY, PATRICK A (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:A
Last Name:COFFEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 LAUREL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9500
Mailing Address - Country:US
Mailing Address - Phone:937-335-3069
Mailing Address - Fax:949-222-6546
Practice Address - Street 1:1640 LAUREL CREEK DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9500
Practice Address - Country:US
Practice Address - Phone:937-335-3069
Practice Address - Fax:949-222-6546
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002088213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000002378OtherANTHEM BLUE CROSS BLUE SHIELD
OH480001264OtherRAILROAD MEDICARE
OH0503075Medicaid
0514842Medicare PIN