Provider Demographics
NPI:1669470621
Name:COFFEY, BEN DEAN (DO)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:DEAN
Last Name:COFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-1181
Mailing Address - Country:US
Mailing Address - Phone:865-213-8594
Mailing Address - Fax:865-213-8596
Practice Address - Street 1:304 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-1181
Practice Address - Country:US
Practice Address - Phone:865-213-8594
Practice Address - Fax:865-213-8596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1242207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3131926OtherBLUE CROSS
TN3305674Medicaid
H00802Medicare UPIN
3305674Medicare ID - Type Unspecified