Healthcare Provider Details

I. General information

NPI: 1457315756
Provider Name (Legal Business Name): JOHN JOSEPH COLEMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-5277
  • Fax: 904-653-4677
Mailing address:
  • Phone: 904-259-5277
  • Fax: 904-653-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0001570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: