Provider Demographics
NPI:1366442618
Name:COLEMAN, BRIAN E (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:E
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 1:4800 LINTON BLVD
Mailing Address - Street 2:BUILDING A -201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6584
Mailing Address - Country:US
Mailing Address - Phone:561-496-6622
Mailing Address - Fax:561-496-3835
Practice Address - Street 1:4800 LINTON BLVD
Practice Address - Street 2:BUILDING A -201
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6584
Practice Address - Country:US
Practice Address - Phone:561-496-6622
Practice Address - Fax:561-496-3835
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040221A207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386686OtherANTHEM BCBS
IN200010680Medicaid
IN234270AOtherMEDICARE INDIVDUAL PROVID
IN000000386686OtherANTHEM BCBS