Provider Demographics
NPI:1548276900
Name:COYLE, STEVEN G (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:COYLE
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 1:2795 LOMA VISTA ROAD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1544
Mailing Address - Country:US
Mailing Address - Phone:805-643-8695
Mailing Address - Fax:805-643-2087
Practice Address - Street 1:2795 LOMA VISTA ROAD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1544
Practice Address - Country:US
Practice Address - Phone:805-643-8695
Practice Address - Fax:805-643-2087
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G449461Medicaid
CA953152550OtherOTHER INSURANCE
CAZZZ82842ZMedicaid
CA951683892OtherOTHER INSURANCE
CARHM18553HMedicaid
CARHM08608FMedicaid
CARHM08609FMedicaid
CA050394OtherBLUE CROSS
CAZZT40394FMedicaid
CA050394OtherBLUE CROSS
CA058609Medicare ID - Type UnspecifiedRH MEDICARE
CARHM18553HMedicaid
CARHM08609FMedicaid
CA951683892OtherOTHER INSURANCE
CA00G449461Medicaid