Provider Demographics
NPI:1104927946
Name:COLEMAN, DAVID R (PA-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E 15TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8938
Mailing Address - Country:US
Mailing Address - Phone:970-669-0400
Mailing Address - Fax:970-669-0400
Practice Address - Street 1:3520 E 15TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8938
Practice Address - Country:US
Practice Address - Phone:970-669-0400
Practice Address - Fax:970-669-0400
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA3439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22882561Medicaid
COCOA107337Medicare PIN
P06989Medicare UPIN