MEDICARE: DR. DOUGLAS C COLTMAN MD

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	207R00000X	Internal Medicine Physician	J7764	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	110205047	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CO08090K0	OTHER	TX	BCBS
3	TIN PLUS SUFFIX 035	OTHER	TX	TRICARE
4	123037	OTHER	TX	CHIPS
6	TIN PLUS SUFFIX 005	OTHER	TX	TRICARE
7	5788303	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1619940442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS C COLTMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 E DOUGLAS BLVD
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8307
Country	:	US
Telephone Number	:	903-593-1721
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	10/10/2014

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Directions to “ DR. DOUGLAS C COLTMAN MD” Practice Location

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