SOUTH COAST DERMATOLOGY LLC (NPI# 1114567377) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114567377 |
| Entity Type | Organization |
| Organization Name | SOUTH COAST DERMATOLOGY LLC |
| Practice Address |
620 Commercial Ave Coos Bay OR 97420-1846 |
| Practice Telephone | 5418083860 |
| Mailing Telephone | 5418083860 |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-01-15 |
| Authorized Official Name | WILLIAM WALLACE WEBSTER (OWNER) |
| Authorized Official Telephone | 5412975342 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215911383 | South Coast Dermatology LLC | Specialist | 90 Libbey Pkwy, Suite 200, Weymouth, MA 02189-3100 | 2005-12-02 |
| Street Address |
620 COMMERCIAL AVE |
| City | COOS BAY |
| State | OR |
| Zip Code | 97420-1846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144237587 | Kathleen Mitchell Brown | Specialist | 620 Commercial Ave, Coos Bay, OR 97420-1846 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346880606 | Danielle Goette | Massage Therapist | 320 Central Ave Suite 226, Coos Bay, OR 97420 | 2020-01-14 |
| 1730643735 | Nicole Hand-therapeutic Massage | Massage Therapist | 3229 Broadway Avenue, Suite D, Coos Bay, OR 97420 | 2019-01-24 |
| 1528531100 | A Better Reality | Clinic/Center | 2690 N. 17th Sstreet, Coos Bay, OR 97420 | 2019-01-07 |
| 1396216883 | Elizabeth Rose Stephens | Health Educator | 97381 Newport Lane, Coos Bay, OR 97420 | 2018-12-10 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1285091884 | Richard T Rigney | Counselor | 62754 Karl Road, Coos Bay, OR 97420 | 2016-01-27 |
| 1821493032 | James Thomas Agee | Pharmacist | 2051 Newmark Avenue, Walmart Pharmacy 1880, Coos Bay, OR 97420 | 2014-10-30 |
| 1346663895 | Steven D. Richardson D.m.d. L.l.c | Dentist | 1835 Ocean Blvd Se, Coos Bay, OR 97420 | 2014-02-03 |
| 1144669243 | Michael Jason Cole | Pharmacist | 1020 South First Ave, Coos Bay, OR 97420 | 2013-06-21 |
| 1639518053 | Jonathan Thomas Small | Physical Therapist | 2645 North 17th St, Coos Bay, OR 97420 | 2013-06-19 |
| Find all providers in zip 97420 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508083189 | Kelly Wayne Smith | Nurse Practitioner | Bay Clinic, LLP, 1750 Thompson Rd, Coos Bay, OR 97420 | 2007-04-18 |
| 1477189009 | Sandy Lynn Teeter | Nurse Practitioner | 1900 Woodland Dr, Coos Bay, OR 97420-2099 | 2020-03-16 |
| 1548518913 | Mihal Anne Kaufman | Nurse Practitioner | 1750 Thompson Rd, Coos Bay, OR 97420-2100 | 2012-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992315972 | Deborah Marie Jones | Nurse Practitioner | 15800 Boones Ferry Rd Ste A6, Lake Oswego, OR 97035-3426 | 2020-08-05 |
| 1184257115 | Joanna Rae Farrell | Nurse Practitioner | 1650 Ne 32nd Ave Apt 425, Portland, OR 97232-3455 | 2020-02-18 |
| 1790241065 | Autumn D Mercer Agnp-c LLC | Nurse Practitioner | 1075 Shayla Ln, Central Point, OR 97502-2995 | 2019-02-12 |
| 1023590841 | Healthy At Home LLC | Nurse Practitioner | 3910 Ne 99th Ave, Portland, OR 97220-3620 | 2018-08-29 |
| 1437648946 | Stephanie Michele Johnson | Nurse Practitioner | 3560 Se 79th Ave, Portland, OR 97206-2372 | 2018-05-09 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| 1003275843 | Catherine Chiaradonna | Nurse Practitioner | 1867 Williams Hwy Ste 226, Grants Pass, OR 97527-5856 | 2016-02-22 |
| 1801266119 | Daniel Dominic Eric Roa | Nurse Practitioner | 5316 N Greeley Ave, Portland, OR 97217-4113 | 2015-09-29 |
| 1538578067 | Karen Lee Warren | Nurse Practitioner | 727 S Wahanna Rd Ste 100, Seaside, OR 97138-7735 | 2014-08-08 |
| 1245579408 | Derek Brent Kordenbrock | Nurse Practitioner | 625 Sw Ramsey Ave Ste A, Grants Pass, OR 97527-5808 | 2013-02-07 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.