Individual
KYLE EUGENE COAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3306 SE WISTER ST, MILWAUKIE, OR 97222
(971) 266-9537
Mailing address
3306 SE WISTER ST, MILWAUKIE, OR 97222-6894
(971) 266-9537
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21273
OR
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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