Provider Demographics
NPI:1720022643
Name:COFFMAN, SHAWN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:WAYNE
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 US ROUTE 60
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2004
Mailing Address - Country:US
Mailing Address - Phone:304-528-4656
Mailing Address - Fax:304-523-7358
Practice Address - Street 1:5170 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-528-4656
Practice Address - Fax:304-523-7358
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV15573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110061746OtherRAILROAD MEDICARE
WV0073270000Medicaid
OH0874942Medicaid
CO0680434Medicare PIN
WV0073270000Medicaid