Provider Demographics
NPI:1205870482
Name:COFFLER, MICKEY SEMO (MD)
Entity type:Individual
Prefix:DR
First Name:MICKEY
Middle Name:SEMO
Last Name:COFFLER
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 WEST ARBOR DRIVE MC 8201
Mailing Address - Street 2:UCSD MEDICAL CENTER
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8201
Mailing Address - Country:US
Mailing Address - Phone:858-657-8745
Mailing Address - Fax:619-543-3183
Practice Address - Street 1:200 WEST ARBOR DRIVE MC 8201
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:858-657-8745
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73812207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A738120Medicaid
CAWA73812AMedicare ID - Type Unspecified
CA00A738120Medicaid