Provider Demographics
NPI:1619902467
Name:COLEMAN, MARTIN E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:E
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 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:954-491-6300
Mailing Address - Fax:954-351-1529
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-491-6300
Practice Address - Fax:954-351-1529
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062535300Medicaid
FL93725OtherBCBS OF FLORIDA
FL93725OtherBCBS OF FLORIDA