Provider Demographics
NPI:1194777235
Name:COYLE, DUSTIN (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:COYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 EAGLE GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-3139
Mailing Address - Country:US
Mailing Address - Phone:801-598-1779
Mailing Address - Fax:801-701-8848
Practice Address - Street 1:36485 INLAND VALLEY DR
Practice Address - Street 2:
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9681
Practice Address - Country:US
Practice Address - Phone:951-677-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168357207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6344Medicaid
UTD6344Medicaid