NPIMap

Organization Active NPI

Dennis W Coffman M.D.

  • Family Medicine Physician
  • Nacogdoches, TX
National Provider Identifier
1255680674
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
EO423 Issued in TX
Legal business name
DENNIS W COFFMAN M.D.
Practice address
4800 N E Stallings Drive
Suite 111
Nacogdoches, TX 75965-1250
Phone
(936) 564-7383
Fax
(936) 569-0549
NPI assigned
Aug 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dennis W Coffman, M.D.NPI 1659421642
Title
Owner
Phone
(936) 564-7383

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X EO423 TX Primary

Addresses

Primary practice location

4800 N E Stallings Drive
Suite 111
Nacogdoches, TX 75965-1250

Mailing address

4800 N E Stallings Drive
Suite 111
Nacogdoches, TX 75965-1250
Phone (936) 564-7383

Other identifiers 1

IdentifierTypeStateIssuer
115582201MedicaidTX

National Provider Directory

National Provider Directory

Locations

4800 NE Stallings Dr
Ste 111
Nacogdoches, TX 75965
Phone (936) 564-7383

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1255680674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N E STALLINGS DRIVE",
            "address_2": "SUITE 111",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651250",
            "telephone_number": "936-564-7383",
            "fax_number": "936-569-0549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 N E STALLINGS DRIVE",
            "address_2": "SUITE 111",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651250",
            "telephone_number": "936-564-7383",
            "fax_number": "936-569-0549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS W COFFMAN M.D.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-30",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "COFFMAN",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "936-564-7383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "EO423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115582201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.