Provider Demographics
NPI:1730158965
Name:COLEMAN, EDWARD O (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:O
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:130 DESIARD ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7319
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:109 REGENCY PL
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4453
Practice Address - Country:US
Practice Address - Phone:318-812-9999
Practice Address - Fax:318-323-9339
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.06658R204D00000X
LADO306658R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1349321Medicaid
5M730Medicare PIN