Provider Demographics
NPI:1831100023
Name:COLEMAN, WILLIAM P (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
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 1:504 MEADOWLAKE CENTER
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3981
Mailing Address - Country:US
Mailing Address - Phone:254-776-7444
Mailing Address - Fax:254-776-9729
Practice Address - Street 1:504 MEADOWLAKE CENTER
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3981
Practice Address - Country:US
Practice Address - Phone:254-776-7444
Practice Address - Fax:254-776-9729
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6910208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD6910OtherSTATE LICENSE
TX00KR79Medicare PIN
TXD6910OtherSTATE LICENSE