Provider Demographics
NPI:1942231782
Name:COFFEY, TOM K (MD)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:K
Last Name:COFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1301 MARICOPA HWY STE B
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3130
Mailing Address - Country:US
Mailing Address - Phone:805-272-8676
Mailing Address - Fax:805-430-6846
Practice Address - Street 1:1301 MARICOPA HWY STE B
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3130
Practice Address - Country:US
Practice Address - Phone:805-272-8676
Practice Address - Fax:203-452-7089
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031622207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3443104002OtherCIANA
010031622CT03OtherBLUE CROSS
P691119OtherOXFORD
003779OtherHEALTHNET
0806723OtherAETNA
1253285OtherUNITED HEALTH
791182OtherCONNECTICARE
010031622CT03OtherBLUE CROSS
1253285OtherUNITED HEALTH