Provider Demographics
NPI:1336147271
Name:COLEMAN, LEE WALKER (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:WALKER
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-2720
Mailing Address - Country:US
Mailing Address - Phone:662-455-4523
Mailing Address - Fax:662-455-3790
Practice Address - Street 1:2005 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-2720
Practice Address - Country:US
Practice Address - Phone:662-455-4523
Practice Address - Fax:662-455-3790
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09501091Medicaid
MSP00059133OtherR/R MEDICARE
MSP00059133OtherR/R MEDICARE
MS180000297Medicare ID - Type Unspecified
MSH92298Medicare UPIN