Basic Information
| Provider Information | |||||||||
| NPI: | 1033176425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COFFMAN | ||||||||
| FirstName: | TOMMY | ||||||||
| MiddleName: | MILLS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2889 10TH AVE N | ||||||||
| Address2: | STE 306 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334613045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612273101 | ||||||||
| FaxNumber: | 5612273182 | ||||||||
| Practice Location | |||||||||
| Address1: | 2889 10TH AVE N | ||||||||
| Address2: | STE 306 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334613045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612273101 | ||||||||
| FaxNumber: | 5612273182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME23499 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 036043100 | 05 | FL | MEDICAID |