Provider Demographics
NPI:1831153097
Name:COLEMAN, ROBYN GAIL (MD)
Entity type:Individual
Prefix:
First Name:ROBYN
Middle Name:GAIL
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 1:2100 LAKESIDE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4351
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:3420 22ND PLACE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-725-1800
Practice Address - Fax:806-723-6532
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7266207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044682502Medicaid
TX8A3349Medicare ID - Type Unspecified
TX044682502Medicaid