Provider Demographics
NPI:1760744460
Name:KOFFIE, ROBERT MAWUNYO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MAWUNYO
Last Name:KOFFIE
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 1:350 W THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1757 E BASELINE RD STE 131
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1534
Practice Address - Country:US
Practice Address - Phone:480-999-5248
Practice Address - Fax:480-999-5285
Is Sole Proprietor?:No
Enumeration Date:2012-06-09
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71969-20207T00000X
AZ59734207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100089494Medicaid
AZ005313Medicaid