Provider Demographics
NPI:1710169420
Name:COLEMAN, ROBERT VANCLEAVE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VANCLEAVE
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3091 HIGHWAY 49 S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9452
Mailing Address - Country:US
Mailing Address - Phone:601-891-8134
Mailing Address - Fax:601-891-8364
Practice Address - Street 1:3091 HIGHWAY 49 S
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9452
Practice Address - Country:US
Practice Address - Phone:601-891-8134
Practice Address - Fax:601-891-8364
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS20086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine