Provider Demographics
NPI:1538436696
Name:COYLE, DONALD (RPSGT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:COYLE
Suffix:
Gender:M
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-0449
Mailing Address - Country:US
Mailing Address - Phone:502-724-7883
Mailing Address - Fax:502-349-6901
Practice Address - Street 1:301 W STEPHEN FOSTER AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1493
Practice Address - Country:US
Practice Address - Phone:502-349-6900
Practice Address - Fax:502-349-6901
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist