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NPI Code Detail

MEDICARE: COLLEEN LINDA COLEMAN M.D.

MEDICARE:   COLLEEN LINDA COLEMAN  M.D.
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
1208600000XSurgery PhysicianG080909CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110946255OTHERCACAQH PROVIDER ID

General Provider Information

NPI Number : 1982647517
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN LINDA COLEMAN M.D.
Provider Business Mailing Address
First Line : 510 SUPERIOR AVE
Second Line : SUITE 200G
City : NEWPORT BEACH
State : CA
Zip : 92663-3663
Country : US
Telephone Number : 949-791-6767
Fax Number : 949-791-6768
Provider Business Practice Location Address
First Line : 510 SUPERIOR AVE
Second Line : SUITE 200-G
City : NEWPORT BEACH
State : CA
Zip : 92663-3663
Country : US
Telephone Number : 949-791-6767
Fax Number : 949-791-6768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 04/16/2015

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Directions to “ COLLEEN LINDA COLEMAN M.D.” Practice Location

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