Provider Demographics
NPI:1063542355
Name:COFFMAN, WESLEY R (PA)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:R
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-521-1516
Mailing Address - Fax:765-521-1331
Practice Address - Street 1:2200 FOREST RIDGE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-521-7385
Practice Address - Fax:765-521-7394
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN10000910A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant