Provider Demographics
NPI:1487619300
Name:COBURN, AMY G (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:COBURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-441-8843
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 450
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-441-8843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6121207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122802505Medicaid
TXP00837098OtherMEDICARE RAILROAD
TX122802506Medicaid
TX122802502Medicaid
TX122802507Medicaid
0360550001OtherPALMETTO GBA
TX8CF306OtherBLUE CROSS BLUE SHIELD
TXP01063009OtherRAILROAD MEDICARE
TXTXB151296Medicare PIN
TXP01063009OtherRAILROAD MEDICARE
TXP00837098OtherMEDICARE RAILROAD
TX8L24125Medicare PIN