Individual
JESSIE DANIEL JUAN COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3215 GATEWAY BLVD W, EL PASO, TX 79903-4225
(915) 598-7246
(915) 633-6598
Mailing address
3215 GATEWAY BLVD W, EL PASO, TX 79903-4225
(915) 598-7246
(915) 633-6598
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
10844
TX
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
Q1377
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346729204
—
TX
Enumeration date
09/25/2011
Last updated
07/21/2022
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