Provider Demographics
NPI:1255322970
Name:COLEMAN, ROBERT L (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-4501
Mailing Address - Country:US
Mailing Address - Phone:620-662-5871
Mailing Address - Fax:620-662-6047
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4501
Practice Address - Country:US
Practice Address - Phone:620-662-5871
Practice Address - Fax:620-662-6047
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00135213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100094380AMedicaid
KS6153280001Medicare NSC
KST86055Medicare UPIN
KS006768Medicare ID - Type Unspecified