Healthcare Provider Details

I. General information

NPI: 1922196708
Provider Name (Legal Business Name): JAIME R COLE P.A-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5605 W EUGIE AVE STE 110
GLENDALE AZ
85304-1273
US

IV. Provider business mailing address

16760 W HILTON AVE
GOODYEAR AZ
85338-7400
US

V. Phone/Fax

Practice location:
  • Phone: 623-847-2000
  • Fax:
Mailing address:
  • Phone: 785-845-4501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3559
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3559
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: