Provider Demographics
NPI:1962473165
Name:COLEMAN, TIMOTHY EDISON (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EDISON
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:1263 LAKE PLAZA DR STE 230
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3512
Practice Address - Country:US
Practice Address - Phone:719-776-3300
Practice Address - Fax:719-776-3329
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 074022207Q00000X
CODR.0048752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2126283Medicaid
CO32403861Medicaid
CO32403861Medicaid
CO32403861Medicaid