Provider Demographics
NPI:1922084631
Name:COFFMAN, STEWART ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ROSS
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:PO BOX 201606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1606
Mailing Address - Country:US
Mailing Address - Phone:972-758-3598
Mailing Address - Fax:
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3641
Practice Address - Country:US
Practice Address - Phone:972-758-3598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1938207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118517502Medicaid
TX84781FOtherBCBS
TX930082501OtherMEDICARE RAILROAD
TX118517507Medicaid
TX930094836OtherMEDICARE RAILROAD
TX118517503Medicaid
TX8A0464OtherBCBS
TX930082501OtherMEDICARE RAILROAD
TX84781FOtherBCBS
TXF59579Medicare UPIN
TX118517507Medicaid