Provider Demographics
NPI:1508818444
Name:COLEMAN, THADDEUS FRAZELL (MD)
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:FRAZELL
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 66
Mailing Address - Street 2:113 WEST CLAY STREET
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150
Mailing Address - Country:US
Mailing Address - Phone:256-246-8511
Mailing Address - Fax:256-249-0314
Practice Address - Street 1:113 WEST CLAY STREET
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150
Practice Address - Country:US
Practice Address - Phone:256-249-8571
Practice Address - Fax:256-249-0314
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL491422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL50962OtherTHE OATH
AL51515489OtherBLUE CROSS BLUE SHIELD
AL51515487OtherBLUE CROSS BLUE SHIELD
AL51515335OtherBLUE CROSS BLUE SHIELD
AL51515488OtherBLUE CROSS BLUE SHIELD
AL009943226Medicaid
AL051553387Medicare ID - Type Unspecified
AL51515488OtherBLUE CROSS BLUE SHIELD
AL51515335OtherBLUE CROSS BLUE SHIELD