Healthcare Provider Details

I. General information

NPI: 1326045428
Provider Name (Legal Business Name): PATRICK SCOTT COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 W CURTISIAN AVE STE 200 6140 W CURTISIAN AVE STE 200
BOISE ID
83704
US

IV. Provider business mailing address

3340 E GOLDSTONE DR.
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-0000
  • Fax: 208-302-0055
Mailing address:
  • Phone: 208-302-0000
  • Fax: 208-302-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG74120
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG74120
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberG74120
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberM-15255
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: