Basic Information
| Provider Information | |||||||||
| NPI: | 1508952805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR DAVID COBURN M.D. PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702408822 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 S 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MONTROSE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702408822 | ||||||||
| FaxNumber: | 9702408823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COBURN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. P.C. | ||||||||
| AuthorizedOfficialTelephone: | 9702408822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.C P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 17871 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 04020780 | 05 | CO | MEDICAID |