Provider Demographics
NPI:1649571738
Name:COLEMAN, VERONICA L (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:DEPARTMENT OF PLASTIC SURGERY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:214-590-6460
Mailing Address - Fax:214-590-4219
Practice Address - Street 1:5201 HARRY HINES BLVD
Practice Address - Street 2:SURGICAL SERVICES CLINICIANS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7708
Practice Address - Country:US
Practice Address - Phone:214-590-1752
Practice Address - Fax:214-590-4219
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA200399363A00000X
TXPA08695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2130081Medicaid
LA5F610PD92Medicare UPIN