Basic Information
| Provider Information | |||||||||
| NPI: | 1437199684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COATES | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 S WINTERGARDEN RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434023544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193537069 | ||||||||
| FaxNumber: | 4193537076 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 BRIAR HILL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | NORTH BALTIMORE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458729504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192571417 | ||||||||
| FaxNumber: | 4192577408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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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 | 207Q00000X | 34007620 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2274686 | 05 | OH | MEDICAID | DA5101 | 01 | OH | RR MEDICARE | OTHER |