Healthcare Provider Details

I. General information

NPI: 1932229648
Provider Name (Legal Business Name): ROBERT DAVID COLEMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

10601 BEAR HOLLOW DR # 31
GOLD RIVER CA
95670-6350
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7793
  • Fax:
Mailing address:
  • Phone: 510-579-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19099
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number19099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: