Provider Demographics
NPI:1881844959
Name:WILLIAM O COLEMAN MD INC
Entity Type:Organization
Organization Name:WILLIAM O COLEMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:OMER
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-949-4227
Mailing Address - Street 1:3435 NW 56TH ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4448
Mailing Address - Country:US
Mailing Address - Phone:405-949-4227
Mailing Address - Fax:405-949-4228
Practice Address - Street 1:3435 NW 56TH ST
Practice Address - Street 2:SUITE 211
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4448
Practice Address - Country:US
Practice Address - Phone:405-949-4227
Practice Address - Fax:405-949-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100121110AMedicaid
OK100121110AMedicaid