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General NPI Number Information
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NPI Number | 1093209090
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Entity Type | Individual
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Provider Name | AUSTIN AXLEY COLE MD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 550 CLUB LN
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City | CONWAY
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State | AR
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Zip | 72034-3681
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Country | US
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Telephone | 501-329-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 5760 GRAND TETON LN
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City | CONWAY
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State | AR
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Zip | 72034-7623
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Country | US
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Telephone | 864-867-8111
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 94-11281
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | E-18048
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License Number State | AR
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