Provider Demographics
NPI:1629180583
Name:COFFMAN, JEFFREY A (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4444 SOUTH 86TH ST.
Mailing Address - Street 2:STE 102
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:402-476-9912
Practice Address - Street 1:4444 SOUTH 86TH ST.
Practice Address - Street 2:STE 102
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:402-476-9912
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE153472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4797265300Medicaid
NE6191OtherBCBS
NE203320000OtherMAGELLAN
NE203320000OtherMAGELLAN