Healthcare Provider Details

I. General information

NPI: 1760404792
Provider Name (Legal Business Name): WILLIAM R COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9535 RESEDA BOULEVARD SUITE 304
NORTHRIDGE CA
91324-6029
US

IV. Provider business mailing address

9535 RESEDA BOULEVARD SUITE 304
NORTHRIDGE CA
91324-6029
US

V. Phone/Fax

Practice location:
  • Phone: 818-886-3884
  • Fax: 818-886-5418
Mailing address:
  • Phone: 818-886-3884
  • Fax: 818-886-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG67719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: