Provider Demographics
NPI:1477086767
Name:COFFEY, DALE D (DO)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:COFFEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7338
Mailing Address - Country:US
Mailing Address - Phone:910-343-0811
Mailing Address - Fax:910-343-5719
Practice Address - Street 1:1411 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7338
Practice Address - Country:US
Practice Address - Phone:910-343-0811
Practice Address - Fax:910-343-5719
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227759390200000X
NC2022-016132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program