Individual
KIMBERLY WILLIS COATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
511 OAKWOOD BLVD, SUITE 200, ROUND ROCK, TX 78681-4007
(512) 255-0769
(512) 255-4569
Mailing address
511 OAKWOOD BLVD, SUITE 200, ROUND ROCK, TX 78681-4007
(512) 255-0769
(512) 255-4569
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
J1937
TX
208800000X
Urology Physician
J1937
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064LP
BCBS INDIVIDUAL
TX
01
—
20-0972212
TAX ID
TX
01
—
J1937
STATE LICENSE NUMBER
TX
Enumeration date
12/19/2006
Last updated
02/11/2008
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