Provider Demographics
NPI:1134597792
Name:COLEMAN, RODRICKER II
Entity type:Individual
Prefix:
First Name:RODRICKER
Middle Name:
Last Name:COLEMAN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-8401
Mailing Address - Country:US
Mailing Address - Phone:352-318-5760
Mailing Address - Fax:
Practice Address - Street 1:1410 SE 20TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-8401
Practice Address - Country:US
Practice Address - Phone:352-318-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health