Provider Demographics
NPI:1770274789
Name:COLEMAN, ROBERT EARL (HOS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EARL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:HOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-5E STEINEL WAY
Mailing Address - Street 2:4TH
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96632
Mailing Address - Country:US
Mailing Address - Phone:510-260-3984
Mailing Address - Fax:
Practice Address - Street 1:65-5E STEINEL WAY
Practice Address - Street 2:4TH
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96632
Practice Address - Country:US
Practice Address - Phone:510-260-3984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA13554762OtherMEDI-CAL