Provider Demographics
NPI:1134493588
Name:COFFEY, BRANDON LUCAS (DO)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LUCAS
Last Name:COFFEY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12432 DAVIE CT
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5789
Mailing Address - Country:US
Mailing Address - Phone:423-215-1485
Mailing Address - Fax:
Practice Address - Street 1:12432 DAVIE CT
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5789
Practice Address - Country:US
Practice Address - Phone:423-215-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2651207P00000X, 207R00000X
FLOS16524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLM1092OtherMEDICARE
FL105941700Medicaid