Provider Demographics
NPI:1972902815
Name:COFFMAN, JARED MICHAEL
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:COFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ODARA DR APT 106
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-3161
Mailing Address - Country:US
Mailing Address - Phone:434-610-0540
Mailing Address - Fax:
Practice Address - Street 1:140 ODARA DR APT 106
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-3161
Practice Address - Country:US
Practice Address - Phone:434-610-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program