Active NPI
Samuel Coleridge
- Family Medicine Physician
- Fort Worth, TX
National Provider Identifier
1013986058
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- J2546
- Practice address
- 2106 N Main St
Fort Worth, TX 76106-8511 - Phone
- (817) 625-4254
- Fax
- (817) 740-1318
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | J2546 | TX | Primary |
Addresses
Primary practice location
2106 N Main St
Fort Worth, TX 76106-8511
Mailing address
3500 Camp Bowie Blvd
Fort Worth, TX 76107-2644
Phone (817) 735-0170
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J2546 | TX | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1013986058",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 CAMP BOWIE BLVD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761072644",
"telephone_number": "817-735-0170",
"fax_number": "817-735-0111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2106 N MAIN ST",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761068511",
"telephone_number": "817-625-4254",
"fax_number": "817-740-1318"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLERIDGE",
"first_name": "SAMUEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "J2546",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.