Provider Demographics
NPI:1912011792
Name:COFFEY, DAVID BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:COFFEY
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:PO BOX 4729
Mailing Address - Street 2:281 UNDERPASS DRIVE
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841
Mailing Address - Country:US
Mailing Address - Phone:423-569-5454
Mailing Address - Fax:423-569-5902
Practice Address - Street 1:281 UNDERPASS DRIVE
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-569-5454
Practice Address - Fax:423-569-5902
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009950207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3708907Medicaid
TN3162697Medicaid
B02959Medicare UPIN