Provider Demographics
NPI:1306909072
Name:COATES, REGINALD ALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:ALVIN
Last Name:COATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7111 WINNETKA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3646
Mailing Address - Country:US
Mailing Address - Phone:818-340-6658
Mailing Address - Fax:818-340-9192
Practice Address - Street 1:7111 WINNETKA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3646
Practice Address - Country:US
Practice Address - Phone:818-340-6658
Practice Address - Fax:818-340-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG37252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A47014Medicare UPIN
G37252Medicare ID - Type Unspecified