Provider Demographics
NPI:1770647877
Name:COLEMAN, ROYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYCE
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 S JACKSON ST
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE C1H17
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1675
Mailing Address - Country:US
Mailing Address - Phone:502-852-5689
Mailing Address - Fax:502-852-4701
Practice Address - Street 1:530 S JACKSON ST
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE C1H17
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1675
Practice Address - Country:US
Practice Address - Phone:502-852-5689
Practice Address - Fax:502-852-4701
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24044207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64240443Medicaid
KY64240443Medicaid
KY0254106Medicare ID - Type Unspecified