Individual
MR. DEREK KELLY COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2001 VAIL AVE, CHARLOTTE, NC 28207-1248
(208) 863-8974
Mailing address
3740 WENDWOOD LN APT 108, CHARLOTTE, NC 28211-1257
(208) 863-8974
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
001006199
NC
363A00000X
Physician Assistant
Primary
0010-06199
NC
Other
Enumeration date
02/19/2016
Last updated
06/10/2020
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