Provider Demographics
NPI:1174559439
Name:COFFMAN, PETER WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:WILLIAM
Last Name:COFFMAN
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 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6379
Mailing Address - Fax:814-375-9320
Practice Address - Street 1:1100 MILLION DOLLAR HWY
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2728
Practice Address - Country:US
Practice Address - Phone:814-781-5420
Practice Address - Fax:814-781-5483
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0740632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018560960007Medicaid
PA000120653OtherHIGHMARK BLUE CROSS
PAG14247Medicare UPIN
PA050532HSUMedicare ID - Type Unspecified