Provider Demographics
NPI:1457315756
Name:COLEMAN, JOHN JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
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 1:159 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2103
Mailing Address - Country:US
Mailing Address - Phone:904-259-5277
Mailing Address - Fax:904-653-4677
Practice Address - Street 1:159 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2103
Practice Address - Country:US
Practice Address - Phone:904-259-5277
Practice Address - Fax:904-653-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001570213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480030619OtherRAILROAD MEDICARE
FL87929OtherBLUE CROSS BLUE SHIELD
FL029623600Medicaid
FL87929DMedicare PIN
FL87929DMedicare ID - Type Unspecified
FL029623600Medicaid