Healthcare Provider Details

I. General information

NPI: 1083141972
Provider Name (Legal Business Name): JEFFREY ANDREW COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 STOCKDALE HWY STE 203
BAKERSFIELD CA
93311-3621
US

IV. Provider business mailing address

3400 DATA DR ATTN CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-8110
  • Fax: 661-587-8220
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA164491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: