Healthcare Provider Details

I. General information

NPI: 1972593176
Provider Name (Legal Business Name): BRADLEY A COLMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N MAYSVILLE AVE
ZANESVILLE OH
43701-6172
US

IV. Provider business mailing address

PO BOX 1821
ZANESVILLE OH
43702-1821
US

V. Phone/Fax

Practice location:
  • Phone: 740-455-3112
  • Fax: 740-455-1364
Mailing address:
  • Phone: 740-455-3342
  • Fax: 740-455-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34003310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: