Basic Information
| Provider Information | |||||||||
| NPI: | 1053371666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFAS | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | KEITH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 BIEHN ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418823818 | ||||||||
| FaxNumber: | 5418829800 | ||||||||
| Practice Location | |||||||||
| Address1: | 2640 BIEHN ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011181 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418823818 | ||||||||
| FaxNumber: | 5418829800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 03/29/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD25846 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00318106 | 01 | OR | RAILROAD MEDICARE | OTHER | 027754 | 05 | OR | MEDICAID |