Provider Demographics
NPI:1780689349
Name:COE, CHANNING B (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANNING
Middle Name:B
Last Name:COE
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 1:1625 SE 3RD AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2521
Mailing Address - Country:US
Mailing Address - Phone:954-467-2013
Mailing Address - Fax:954-355-4390
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-467-2013
Practice Address - Fax:954-355-4390
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME82390207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265511000Medicaid
FL265511000Medicaid
FLE7826AMedicare ID - Type Unspecified