Healthcare Provider Details

I. General information

NPI: 1104038439
Provider Name (Legal Business Name): WILLIAM PATRICK COLEMAN IV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 CONLIN ST
METAIRIE LA
70006-2123
US

IV. Provider business mailing address

4425 CONLIN ST
METAIRIE LA
70006-2123
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-3180
  • Fax:
Mailing address:
  • Phone: 504-455-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.200588
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberMD.200588
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD.200588
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: