Organization
WILD RIVERS PHYSIATRY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL COELHO M.D. (PRESIDENT)
(707) 464-7840
Entity
Organization
Contact information
Practice address
585 5TH ST, BROOKINGS, OR 97415-9702
(707) 464-7840
(707) 464-7845
Mailing address
PO BOX 950, GOLD BEACH, OR 97444-0950
(707) 464-7840
(707) 464-7845
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD26085
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273955
—
OR
01
—
RHD146992
RADIOGRAPHY AND FLUOROSCOPY
OR
Enumeration date
04/22/2008
Last updated
04/22/2008
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