Provider Demographics
NPI:1386730737
Name:COATS, TIMOTHY MCCARTY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MCCARTY
Last Name:COATS
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 1:545 E CLEVELAND ST STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5535
Mailing Address - Country:US
Mailing Address - Phone:209-472-8400
Mailing Address - Fax:209-472-3375
Practice Address - Street 1:545 E CLEVELAND ST STE A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5535
Practice Address - Country:US
Practice Address - Phone:209-472-8400
Practice Address - Fax:209-472-3375
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G325010Medicaid
G325010Medicare UPIN
00G325010Medicare ID - Type Unspecified