Healthcare Provider Details

I. General information

NPI: 1124021134
Provider Name (Legal Business Name): TERRENCE W COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 GLENN HENDREN DR STE 411B
LIBERTY MO
64068-3388
US

IV. Provider business mailing address

2521 GLENN HENDREN DR STE 411B
LIBERTY MO
64068-3388
US

V. Phone/Fax

Practice location:
  • Phone: 816-429-6057
  • Fax: 816-429-5709
Mailing address:
  • Phone: 816-429-6057
  • Fax: 816-429-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberR8D65
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: