Healthcare Provider Details

I. General information

NPI: 1891957320
Provider Name (Legal Business Name): CHARLES R COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SAINT VINCENT CIR STE 501
LITTLE ROCK AR
72205-5414
US

IV. Provider business mailing address

5 SAINT VINCENT CIR STE 501
LITTLE ROCK AR
72205-5414
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-2894
  • Fax: 501-666-9017
Mailing address:
  • Phone: 501-666-2894
  • Fax: 501-666-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberE11494
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: