Healthcare Provider Details

I. General information

NPI: 1205063435
Provider Name (Legal Business Name): ALAN COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 11TH ST
WICHITA FALLS TX
76301
US

IV. Provider business mailing address

3402 OXFORD LN
WICHITA FALLS TX
76310-1787
US

V. Phone/Fax

Practice location:
  • Phone: 940-764-3608
  • Fax: 940-764-3611
Mailing address:
  • Phone: 806-224-3238
  • Fax: 940-764-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberBP10034012
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberBP10034012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: