Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 685397 | TX |
NPI | 1003153628 |
---|---|
Provider Name | Mr. Richard Coleman JR. |
First Address | Edinburg, TX 78539 |
Second Address | Rio Grande City, TX 78582 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2013 |
Last Update Date | 12/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
332242204 | (05) | TX |