Healthcare Provider Details

I. General information

NPI: 1831152289
Provider Name (Legal Business Name): PAUL ALLEN COLEMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 HIGHWAY 15 S
HUTCHINSON MN
55350-5000
US

IV. Provider business mailing address

1431 PREMIER DR
MANKATO MN
56001-6076
US

V. Phone/Fax

Practice location:
  • Phone: 320-484-4400
  • Fax:
Mailing address:
  • Phone: 507-386-6600
  • Fax: 507-625-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9900
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: