Basic Information
| Provider Information | |||||||||
| NPI: | 1306052527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | CHISOLM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 GULF BREEZE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325617809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509163700 | ||||||||
| FaxNumber: | 8509163710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 GULF BREEZE PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GULF BREEZE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325617809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509163700 | ||||||||
| FaxNumber: | 8509163710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XS0106X | ME113317 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 14LU9 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 592-17944 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER | 592-18009 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 006377300 | 05 | FL | MEDICAID | 141061 | 05 | AL | MEDICAID |