Provider Demographics
NPI:1043026859
Name:COLEMAN, GARY (MCC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-1207
Mailing Address - Country:US
Mailing Address - Phone:303-336-1657
Mailing Address - Fax:303-388-2808
Practice Address - Street 1:1620 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1207
Practice Address - Country:US
Practice Address - Phone:720-814-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator