Provider Demographics
NPI:1508890690
Name:COLEMAN, RYAN BRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:BRETT
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11880
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-1880
Mailing Address - Country:US
Mailing Address - Phone:479-452-1581
Mailing Address - Fax:479-452-2148
Practice Address - Street 1:1115 S WALDRON RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2551
Practice Address - Country:US
Practice Address - Phone:497-452-1581
Practice Address - Fax:479-452-2148
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-8240207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129340001Medicaid