MEDICARE: COLEMAN MEDICAL CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2001027307	MO

General Provider Information

NPI Number	:	1548459472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLEMAN MEDICAL CLINIC

Provider Business Mailing Address
First Line	:	1101 WEBER RD
Second Line	:	SUITE 303
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3326
Country	:	US
Telephone Number	:	575-747-0022
Fax Number	:	573-747-0055

Provider Business Practice Location Address
First Line	:	1101 WEBER RD
Second Line	:	SUITE 303
City	:	FARMINGTON
State	:	MO
Zip	:	63640-3326
Country	:	US
Telephone Number	:	575-747-0022
Fax Number	:	573-747-0055

Authorized Official
Title or Position	:	DOCTOR
Name	:	DAVID W COLEMAN
Credential	:	D.O.
Telephone Number	:	573-747-0022

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	10/16/2007

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Directions to “COLEMAN MEDICAL CLINIC ” Practice Location

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