Individual
PATRICK SCOTT COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6140 W CURTISIAN AVE STE 200, 6140 W CURTISIAN AVE STE 200, BOISE, ID 83704
(208) 302-0000
(208) 302-0055
Mailing address
3340 E GOLDSTONE DR., MERIDIAN, ID 83642
(208) 302-0000
(208) 302-0055
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
G74120
CA
207RI0011X
Interventional Cardiology Physician
G74120
CA
207RI0011X
Interventional Cardiology Physician
Primary
M-15255
ID
207UN0901X
Nuclear Cardiology Physician
G74120
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G741200
BLUE SHIELD OF CALIFORNIA
CA
05
—
00G741200
—
CA
01
—
060017509
RAILROAD MEDICARE
CA
Enumeration date
07/05/2005
Last updated
11/04/2020
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