Provider Demographics
NPI:1487614376
Name:COFFIELD, KING SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:KING
Middle Name:SCOTT
Last Name:COFFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:K.
Other - Middle Name:SCOTT
Other - Last Name:COFFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-0001
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9969208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX807483OtherBLUE SHIELD
TX1010209-02OtherCSHCN
TX340018398OtherRR/MEDICARE
TX807483OtherBLUE SHIELD
TX807483Medicare ID - Type Unspecified
TX340018398OtherRR/MEDICARE