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Individual

DR. JIMMY R COUGHRAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
101 FAIR AVENUE, WINNSBORO, LA 71295-2116
(318) 435-8020
(318) 435-8099
Mailing address
PO BOX 730, WINNSBORO, LA 71295-0730
(318) 435-8020
(318) 435-8099

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
021579
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1449130
LA
05
1971391
LA
01
5287021
AETNA PROVIDER NUMBER
LA
01
L92023
VANTAGE PROVIDER
LA
Enumeration date
02/23/2006
Last updated
12/12/2012
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