MEDICARE: MATTHEW DAVID 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	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	12960	NV
2	207ZB0001X	Blood Banking & Transfusion Medicine Physician	12960	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215937479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW DAVID COLEMAN MD

Provider Business Mailing Address
First Line	:	6930 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1602
Country	:	US
Telephone Number	:	702-304-6515
Fax Number	:

Provider Business Practice Location Address
First Line	:	6930 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1602
Country	:	US
Telephone Number	:	702-304-6515
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/04/2009

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