Provider Demographics
NPI:1164737078
Name:COLEMAN, CHARLES F (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:F
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10303 CRYSTAL FLD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6742
Mailing Address - Country:US
Mailing Address - Phone:210-682-2248
Mailing Address - Fax:
Practice Address - Street 1:10303 CRYSTAL FLD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6742
Practice Address - Country:US
Practice Address - Phone:210-682-2248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80261133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered