Provider Demographics
NPI:1548267669
Name:COLEMAN, JAMIE M (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:M
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0031
Mailing Address - Country:US
Mailing Address - Phone:509-619-0562
Mailing Address - Fax:509-396-7015
Practice Address - Street 1:1610 PENNY LN
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4477
Practice Address - Country:US
Practice Address - Phone:509-529-3160
Practice Address - Fax:509-396-7015
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029648207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA180015287OtherRAILROAD MEDICARE
WA1077544Medicaid
OR056874Medicaid
OR056874Medicaid
0669740001Medicare NSC
WAG001300062Medicare PIN