Provider Demographics
NPI:1174671192
Name:COLEMAN, ROBERT E (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DO
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 1022
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-3022
Mailing Address - Country:US
Mailing Address - Phone:509-837-4366
Mailing Address - Fax:509-837-4344
Practice Address - Street 1:10TH AND TACOMA
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-3022
Practice Address - Country:US
Practice Address - Phone:509-837-4366
Practice Address - Fax:509-837-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000016242085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7094824Medicaid
WAGAB08314Medicare PIN
E14315Medicare UPIN