Provider Demographics
NPI:1689652307
Name:COLEMAN, SCOTT KEITH
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:KEITH
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 SADDLE BRONC DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7045
Mailing Address - Country:US
Mailing Address - Phone:915-593-2033
Mailing Address - Fax:915-595-3916
Practice Address - Street 1:1160 SADDLE BRONC DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7045
Practice Address - Country:US
Practice Address - Phone:915-593-2033
Practice Address - Fax:915-595-3916
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121296102Medicaid