Provider Demographics
NPI:1316122245
Name:COATS, WALTER CHRISTOPHER (DO)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CHRISTOPHER
Last Name:COATS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 W TRUMAN BLVD # A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-0514
Mailing Address - Country:US
Mailing Address - Phone:573-636-0635
Mailing Address - Fax:573-659-4685
Practice Address - Street 1:3501 W TRUMAN BLVD # A
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-0514
Practice Address - Country:US
Practice Address - Phone:573-636-0635
Practice Address - Fax:573-659-4685
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.001803207R00000X
MO2008010692207RC0000X
IL036127845207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO504645102Medicaid