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General NPI Number Information
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NPI Number | 1679500946
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Entity Type | Organization
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Legal Business Name | M COLEMAN DRIVER JR MD PA
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 303 W. HARRIS AVE. SUITE 3
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City | SAN ANGELO
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State | TX
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Zip | 76903-6377
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Country | US
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Telephone | 325-942-9300
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Fax | 325-942-9333
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Provider Business Mailing Address
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Address Line | 303 W. HARRIS AVE. SUITE 3
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City | SAN ANGELO
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State | TX
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Zip | 76903-6377
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Country | US
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Telephone | 325-942-9300
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Fax | 325-942-9333
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | BRYAN N ANGLE
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Credential | MD
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Telephone | 325-942-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | E7897
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | J1844
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License Number State | TX
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