Healthcare Provider Details

I. General information

NPI: 1841294881
Provider Name (Legal Business Name): JOSEPH IRA COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N QUINCY AVE
OTTUMWA IA
52501-3866
US

IV. Provider business mailing address

920 N QUINCY AVE
OTTUMWA IA
52501-3866
US

V. Phone/Fax

Practice location:
  • Phone: 641-455-5200
  • Fax: 641-455-5150
Mailing address:
  • Phone: 641-455-5200
  • Fax: 641-455-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35868
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: