Provider Demographics
NPI:1316051873
Name:COFFMAN, JAMYE L (MD)
Entity type:Individual
Prefix:
First Name:JAMYE
Middle Name:L
Last Name:COFFMAN
Suffix:
Gender:F
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4095
Practice Address - Fax:682-885-7445
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7578208000000X, 2080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138664123Medicaid
TX138664121Medicaid
TX138664120Medicaid
TX137283104Medicaid
TX1789904OtherUHC PIN
TX88627XOtherBCBSTX IND PIN
1669442042OtherGRP NPI NUMBER
TX2930641OtherCIGNA PIN
TX00L42VOtherBCBSTX GRP PIN
TX1040178OtherFIRSTHEALTH PIN
TX138664110Medicaid
TX5237604OtherAETNA PIN
TX8702J0Medicare PIN
TX00L42VOtherBCBSTX GRP PIN
TX110543100OtherFIRSTCARE PIN
TX138664110Medicaid