Healthcare Provider Details

I. General information

NPI: 1821081712
Provider Name (Legal Business Name): PATRICIA L COLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N NEW BALLAS RD STE 270 W
SAINT LOUIS MO
63141-6835
US

IV. Provider business mailing address

450 N NEW BALLAS RD STE 270 W
SAINT LOUIS MO
63141-6835
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-6969
  • Fax: 314-997-6969
Mailing address:
  • Phone: 314-991-6969
  • Fax: 314-997-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR1G19
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: