Individual
THOMAS J COFFMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 E IDAHO ST STE 100, BOISE, ID 83712-6202
(208) 338-0148
(208) 336-4027
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 336-4027
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
M5628
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000054
REGENCE BLUE SHIELD OF ID
ID
05
—
000476900
—
ID
01
—
56283
BLUE CROSS OF IDAHO
ID
Enumeration date
09/09/2005
Last updated
11/30/2023
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