Healthcare Provider Details

I. General information

NPI: 1780882365
Provider Name (Legal Business Name): KEEL COLEMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE
ROANOKE VA
24014
US

IV. Provider business mailing address

P.O. BOX 40032
ROANOKE VA
24022
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6331
  • Fax:
Mailing address:
  • Phone: 540-266-6331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102202362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: