Organization
COASTAL CARDIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD BODAGER (CEO)
(541) 789-5600
Entity
Organization
Contact information
Practice address
412 ALDER ST, BROOKINGS, OR 97415-9014
(541) 412-7799
Mailing address
412 ALDER ST, BROOKINGS, OR 97415-9014
(541) 412-7799
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
2498
OR
Other
Enumeration date
08/01/2006
Last updated
08/22/2020
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