Jack Andrew Coleman Jr., MD
Individual provider Active NPI Otolaryngology Physician · Siloam Springs, AR
NPI 1699764258 · NPPES record last updated May 20, 2013
Key facts
- NPI
- 1699764258
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- License
- MD16783 (TN)
- Practice address
- 1101-3 N. Progress Ave.
Siloam Springs, AR 72761-4343 - Phone
- (479) 549-4055
- Fax
- (479) 549-4059
- NPI assigned
- Oct 17, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD16783 | TN | MD | Otolaryngology Physician |
| 16783 | TN | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chesapeake Ear, Nose & Throat Associates, P.C. | Otolaryngology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | MD16783 | TN | Yes |
Addresses
Primary practice location
1101-3 N. Progress Ave.
Siloam Springs, AR 72761-4343
Mailing address
1101-3 N. Progress Ave.
Siloam Springs, AR 72761-4343
Phone (479) 549-4055
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3017988 | Medicaid | TN |
Other providers in Siloam Springs, AR
- Whitly Nicole Cochran
- Jacob Cazort Cockcroft
- Chelsea Kaitlyn Coffelt
- Sloane Audie Coffey
- Ezra Lee Cole
- Mary A Coleman
- Veronica Yamilet Collier
- Cheryl Raye Comfort
- Tauri Rose Cooley
- Donna Marie Copeland
All providers in Siloam Springs, AR · Otolaryngology Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.