Provider Demographics
NPI:1295048031
Name:COYNE, CHARLES PATRICK III (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:PATRICK
Last Name:COYNE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3536 KUHNE RD
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-2573
Mailing Address - Country:US
Mailing Address - Phone:573-437-4168
Mailing Address - Fax:
Practice Address - Street 1:521 ANWIJO WAY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1388
Practice Address - Country:US
Practice Address - Phone:636-456-6103
Practice Address - Fax:636-456-6124
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO201024955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine