Provider Demographics
NPI:1407857931
Name:COLEMAN, GARY MERRILL (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MERRILL
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:PO BOX 73627
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3627
Mailing Address - Country:US
Mailing Address - Phone:281-444-3278
Mailing Address - Fax:832-249-3861
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:281-444-3278
Practice Address - Fax:832-249-3861
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8054207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127740202Medicaid
TX8B2278Medicare ID - Type Unspecified
TX127740202Medicaid