Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 01039034 | IN |
NPI | 1033120340 |
---|---|
Provider Name | Dr. John J. Coleman III |
First Address | Indianapolis, IN 46202-5112 |
Second Address | Indianapolis, IN 46202-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D45099 | (02) | IN |