Provider Demographics
NPI:1497043269
Name:ANTON COLEMAN, MUNCH E. BACKEN, PA
Entity Type:Organization
Organization Name:ANTON COLEMAN, MUNCH E. BACKEN, PA
Other - Org Name:CENTER & MEMORY RESEARCH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-406-2222
Mailing Address - Street 1:PO BOX 7518
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3202 SERENITY CT
Practice Address - Street 2:#102
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34114-9576
Practice Address - Country:US
Practice Address - Phone:405-406-2222
Practice Address - Fax:239-498-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME985982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR162490Medicare PIN
FLFJ864AMedicare PIN