Provider Demographics
NPI:1386738862
Name:COTY, PAUL C (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:COTY
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 1:543 CHALAN GUMA YU'OS
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3630
Mailing Address - Country:US
Mailing Address - Phone:671-649-4764
Mailing Address - Fax:671-649-4765
Practice Address - Street 1:543 CHALAN GUMA YU'OS
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3630
Practice Address - Country:US
Practice Address - Phone:671-649-4764
Practice Address - Fax:671-649-4765
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12487207RH0003X
GUM-1839207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI539596-01Medicaid
HI0000242404OtherHMSA BILLING NUMBER
HI539596-01Medicaid
HI0000242404OtherHMSA BILLING NUMBER