Healthcare Provider Details

I. General information

NPI: 1962072991
Provider Name (Legal Business Name): MONTANA COLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31608 US HIGHWAY 19 N
PALM HARBOR FL
34684-3723
US

IV. Provider business mailing address

1329 SW 16TH ST
GAINESVILLE FL
32608-1128
US

V. Phone/Fax

Practice location:
  • Phone: 727-787-7077
  • Fax:
Mailing address:
  • Phone: 352-733-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberME174678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number33993
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberME174678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: