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Individual

MR. CORNELIUS IRVIN COLEMAN I

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
11428 E 20TH ST, TULSA, OK 74128-6451
(918) 878-7877
Mailing address
3610 N LANSING AVE, TULSA, OK 74106-1625
(918) 693-8551
(918) 574-2038

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200287120A
OK
Enumeration date
03/21/2013
Last updated
03/21/2013
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