Individual
MR. BRADLEY PHILIP COUGHLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2767 JANITELL RD, COLORADO SPRINGS, CO 80906-4102
(719) 365-2888
Mailing address
1650 COCHRANE CIR BLDG 7505, CREDENTIALS OFFICE RM # 163, COLORADO SPRINGS, CO 80913-4613
(719) 526-2092
(719) 526-7732
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2850
CO
363AS0400X
Surgical Physician Assistant
0110002173
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010213355
—
VA
01
—
P00306338
RAILROAD MEDICARE
VA
01
—
TN0141
JOHN DEERE HEALTH
VA
Enumeration date
01/05/2006
Last updated
05/12/2020
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