Individual
J. COFFY PIETERNELLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5060 SHADOW LN, BEAUMONT, TX 77706-7632
(409) 899-1499
(409) 899-1354
Mailing address
5060 SHADOW LN, BEAUMONT, TX 77706-7632
(409) 656-1163
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
H5946
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127792303
—
TX
01
—
160036972
RAILROAD MEDICARE
TX
Enumeration date
09/01/2005
Last updated
11/12/2024
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