Healthcare Provider Details

I. General information

NPI: 1639366511
Provider Name (Legal Business Name): J DEAN COLE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 340
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 340
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-895-8890
  • Fax: 407-895-3608
Mailing address:
  • Phone: 407-895-8890
  • Fax: 407-895-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH H STAFFORD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 407-895-8890