Provider Demographics
NPI:1124216551
Name:COLEMAN, ASHLEY DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:DAN
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:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1276
Mailing Address - Country:US
Mailing Address - Phone:251-990-1922
Mailing Address - Fax:
Practice Address - Street 1:188 HOSPITAL DR
Practice Address - Street 2:STE 202
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2043
Practice Address - Country:US
Practice Address - Phone:251-990-1922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529700760Medicaid
ALF712OtherMEDICARE GROUP PTAN
AL140544Medicaid
AL143992Medicaid
AL102I084629OtherMEDICARE PROVIDER PTAN
AL1124216551OtherINDIVIDUAL NPI
AL541003926Medicaid
AL1750393682OtherNPI GROUP