Provider Demographics
NPI:1245681410
Name:COFFMAN, MATTHEW DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:COFFMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:36065 SANTA FE AVE
Mailing Address - Street 2:CRD ARMY MEDICAL CENTER
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5001
Mailing Address - Country:US
Mailing Address - Phone:254-553-3779
Mailing Address - Fax:254-288-2306
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:CRD ARMY MEDICAL CENTER
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5001
Practice Address - Country:US
Practice Address - Phone:254-553-3779
Practice Address - Fax:254-288-2306
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2022-04-01
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Provider Licenses
StateLicense IDTaxonomies
CODR.0059448207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN