Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9042 | TX |
NPI | 1063539724 |
---|---|
Provider Name | Dr. James Preston Coleman III |
First Address | San Antonio, TX 78218 |
Second Address | San Antonio, TX 78218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T12736 | (02) | TX |