Provider Demographics
NPI:1932288644
Name:COATES, MARK ANDREW (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:COATES
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3156
Mailing Address - Country:US
Mailing Address - Phone:361-654-2064
Mailing Address - Fax:361-654-2068
Practice Address - Street 1:601 TEXAN TRL
Practice Address - Street 2:SUITE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2549
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:361-806-5040
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2019-02-05
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Provider Licenses
StateLicense IDTaxonomies
TXPA04556363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127196Medicare PIN