Provider Demographics
NPI:1801894654
Name:COFFEY, JAMIE P (DPM)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:P
Last Name:COFFEY
Suffix:
Gender:M
Credentials:DPM
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 793
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0793
Mailing Address - Country:US
Mailing Address - Phone:480-892-3180
Mailing Address - Fax:480-892-1891
Practice Address - Street 1:2451 E BASELINE RD
Practice Address - Street 2:STE. C-230
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2471
Practice Address - Country:US
Practice Address - Phone:480-892-3180
Practice Address - Fax:480-892-1891
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1133950002OtherMEDICARE NSC
AZ860739161Medicare PIN
AZ1133950002OtherMEDICARE NSC