Healthcare Provider Details

I. General information

NPI: 1003543901
Provider Name (Legal Business Name): ROBERT COLE FORE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

2522 FORT WORTH AVE APT 118
DALLAS TX
75211-1716
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone: 903-490-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1082702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: