Provider Demographics
NPI:1760458301
Name:COFFMAN, AVON C (DO)
Entity Type:Individual
Prefix:
First Name:AVON
Middle Name:C
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5330 N OAK TRFY
Mailing Address - Street 2:STE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4699
Mailing Address - Country:US
Mailing Address - Phone:816-454-0666
Mailing Address - Fax:816-454-1694
Practice Address - Street 1:5330 N OAK TRFY
Practice Address - Street 2:STE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4699
Practice Address - Country:US
Practice Address - Phone:816-454-0666
Practice Address - Fax:816-454-1694
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7G78207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00331181OtherRAILROAD MEDICARE
MO040008580OtherRAILROAD MEDICARE
C50615Medicare UPIN
MOG266905BMedicare PIN
MO040008580OtherRAILROAD MEDICARE