Healthcare Provider Details

I. General information

NPI: 1952415424
Provider Name (Legal Business Name): STEVE COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 MADISON AVE STE 210
MEMPHIS TN
38104-6428
US

IV. Provider business mailing address

1750 MADISON AVE STE 210
MEMPHIS TN
38104-6428
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-4055
  • Fax: 901-726-4887
Mailing address:
  • Phone: 901-726-4055
  • Fax: 901-726-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD0000015712
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: