Provider Demographics
NPI:1700923075
Name:COE, JASON (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:COE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:530 DEMOSS STREET
Mailing Address - Street 2:HIDALGO MEDICAL SERVICES INC
Mailing Address - City:LORDSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:80045-2632
Mailing Address - Country:US
Mailing Address - Phone:575-542-8384
Mailing Address - Fax:575-542-8367
Practice Address - Street 1:114 WEST 11TH STREET
Practice Address - Street 2:HMS MED SQUARE CLINIC
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88066
Practice Address - Country:US
Practice Address - Phone:575-388-1511
Practice Address - Fax:575-388-3465
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2008-01732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68381867Medicaid
NM300468Medicare PIN