Healthcare Provider Details

I. General information

NPI: 1104927946
Provider Name (Legal Business Name): DAVID R COLEMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST SUITE 200
LOVELAND CO
80538-8938
US

IV. Provider business mailing address

3520 E 15TH ST SUITE 200
LOVELAND CO
80538-8938
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-0400
  • Fax: 970-669-0400
Mailing address:
  • Phone: 970-669-0400
  • Fax: 970-669-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3439
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: