MEDICARE: MR. WYCHE TAYLOR COLEMAN JR. M.D.

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	207P00000X	Emergency Medicine Physician	015031	LA
2	207Q00000X	Family Medicine Physician	015031	LA

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

General Provider Information

NPI Number	:	1710984513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WYCHE TAYLOR COLEMAN JR. M.D.

Provider Business Mailing Address
First Line	:	1633 MARVEL ST
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019-9022
Country	:	US
Telephone Number	:	318-932-9980
Fax Number	:	318-932-9906

Provider Business Practice Location Address
First Line	:	1633 MARVEL ST
Second Line	:
City	:	COUSHATTA
State	:	LA
Zip	:	71019-9022
Country	:	US
Telephone Number	:	318-932-9980
Fax Number	:	318-932-9906

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/26/2023

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Directions to “ MR. WYCHE TAYLOR COLEMAN JR. M.D.” Practice Location

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