Healthcare Provider Details

I. General information

NPI: 1053417428
Provider Name (Legal Business Name): PERRY J COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 05/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 UNIVERSITY BLVD S SUITE 300
JACKSONVILLE FL
32216-2742
US

IV. Provider business mailing address

3100 UNIVERSITY BLVD S SUITE 300
JACKSONVILLE FL
32216-2742
US

V. Phone/Fax

Practice location:
  • Phone: 904-274-8813
  • Fax: 904-503-4465
Mailing address:
  • Phone: 904-274-8813
  • Fax: 904-503-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME83999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: