Provider Demographics
NPI:1982687455
Name:COUCHMAN, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:COUCHMAN
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 43100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85733-3100
Mailing Address - Country:US
Mailing Address - Phone:520-648-5437
Mailing Address - Fax:
Practice Address - Street 1:2350 N KIBLER PL
Practice Address - Street 2:STE. 1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2100
Practice Address - Country:US
Practice Address - Phone:520-648-5437
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ431346Medicaid
AZ10634Medicare ID - Type Unspecified
H09181Medicare UPIN