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Individual
COLEMAN O MARTIN
Active
Individual
COLEMAN O MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
33559
IA
2084V0102X
Vascular Neurology Physician
33559
IA
2085N0700X
Neuroradiology Physician
Primary
33559
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0215111
—
IA
01
—
20021
WELLMARK BCBS
IA
Enumeration date
08/16/2005
Last updated
12/12/2007
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