Provider Demographics
NPI:1336111715
Name:COFFEE, CHARLES CREED (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CREED
Last Name:COFFEE
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 650252
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0252
Mailing Address - Country:US
Mailing Address - Phone:888-804-3000
Mailing Address - Fax:817-334-0235
Practice Address - Street 1:2000 E. LAMAR
Practice Address - Street 2:400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006
Practice Address - Country:US
Practice Address - Phone:888-804-3000
Practice Address - Fax:817-334-0235
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2545207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033982203Medicaid
8D9595Medicare PIN
F36296Medicare UPIN