Provider Demographics
NPI:1487663928
Name:COLEMAN, ROBERT V (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
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 1:410 CELEBRATION PLACE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5436
Mailing Address - Country:US
Mailing Address - Phone:407-303-4855
Mailing Address - Fax:407-303-4404
Practice Address - Street 1:410 CELEBRATION PLACE
Practice Address - Street 2:SUITE 306
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5436
Practice Address - Country:US
Practice Address - Phone:407-303-4855
Practice Address - Fax:407-303-4404
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27000207RE0101X
FLME118136207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200354370AMedicaid
I43142Medicare UPIN
067330Medicare ID - Type Unspecified