Healthcare Provider Details

I. General information

NPI: 1720320062
Provider Name (Legal Business Name): COLLEEN MARIE MARTY COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COLLEEN MARTY MD

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE STE 120C
SPOKANE WA
99204-2302
US

IV. Provider business mailing address

PO BOX 31001-4114
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-3854
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD61043121
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberMD61043121
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9148185-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: