MEDICARE: DR. TERRENCE W COLEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	R8D65	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R8D65	OTHER	MO	MEDICAL LICENSE

General Provider Information

NPI Number	:	1124021134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRENCE W COLEMAN MD

Provider Business Mailing Address
First Line	:	2521 GLENN HENDREN DR STE 411B
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3388
Country	:	US
Telephone Number	:	816-429-6057
Fax Number	:	816-429-5709

Provider Business Practice Location Address
First Line	:	2521 GLENN HENDREN DR STE 411B
Second Line	:
City	:	LIBERTY
State	:	MO
Zip	:	64068-3388
Country	:	US
Telephone Number	:	816-429-6057
Fax Number	:	816-429-5709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/22/2019

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