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NPI Code Detail

MEDICARE: DONALD GLEN COLES M.D.

MEDICARE: DONALD GLEN COLES M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician16641OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10784740001OTHERDMERC REGION C

General Provider Information

NPI Number : 1639114507
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONALD GLEN COLES M.D.
Provider Business Mailing Address
First Line : 11000 HEFNER POINTE DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5039
Country : US
Telephone Number : 405-749-9655
Fax Number : 405-749-1001
Provider Business Practice Location Address
First Line : 11000 HEFNER POINTE DR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73120-5039
Country : US
Telephone Number : 405-749-9655
Fax Number : 405-749-1001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 07/08/2007

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