=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043131014
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. RICHARD WILLIAM COLEMAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9040 COWPEN BRANCH RD
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32145-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-502-0024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9040 COWPEN BRANCH RD
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32145-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-599-3624
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 224P00000X
-----------------------------------------------------
Taxonomy Name | Prosthetist
-----------------------------------------------------
License Number | POR143
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------