Provider Demographics
NPI:1376040444
Name:COLEMAN, IVORIE (MD)
Entity Type:Individual
Prefix:
First Name:IVORIE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7373 N SCOTTSDALE RD STE C190
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3754
Mailing Address - Country:US
Mailing Address - Phone:480-888-5029
Mailing Address - Fax:
Practice Address - Street 1:7373 N SCOTTSDALE RD STE C190
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3754
Practice Address - Country:US
Practice Address - Phone:480-888-5029
Practice Address - Fax:480-903-7989
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty