Provider Demographics
NPI:1902469208
Name:COE, IAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:PATRICK
Last Name:COE
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 1:600 RANCH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97467-1795
Mailing Address - Country:US
Mailing Address - Phone:541-271-2171
Mailing Address - Fax:541-271-6380
Practice Address - Street 1:620 RANCH RD
Practice Address - Street 2:
Practice Address - City:REEDSPORT
Practice Address - State:OR
Practice Address - Zip Code:97467-1796
Practice Address - Country:US
Practice Address - Phone:541-271-2163
Practice Address - Fax:541-271-4058
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT390200000X
ORMD210308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500807267Medicaid