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General NPI Number Information
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NPI Number | 1053390120
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Entity Type | Individual
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Provider Name | DANIEL AGEE COLES M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/17/2006
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 1700 CERRILLOS RD
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City | SANTA FE
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State | NM
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Zip | 87505-3554
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Country | US
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Telephone | 505-988-9821
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 WILDERNESS GATE RD
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City | SANTA FE
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State | NM
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Zip | 87505-5919
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Country | US
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Telephone | 505-982-4420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD2005-0503
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License Number State | NM
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