Individual
DR. CHARLES GRANNIS COFFEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
819 ASH ST, SPOONER, WI 54801-1201
(715) 635-2111
(715) 635-8674
Mailing address
339 E PATTON ST, PO BOX 368, GOLCONDA, IL 62938-1050
(877) 593-4433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44970-020
WI
Other
Enumeration date
06/06/2006
Last updated
07/08/2007
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