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General NPI Number Information
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NPI Number | 1124017819
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Entity Type | Organization
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Legal Business Name | GARY B COLE, MD, PA
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 901 N JEFFERSON AVE
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City | MT PLEASANT
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State | TX
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Zip | 75455-3259
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Country | US
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Telephone | 903-577-7700
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Fax | 903-577-7706
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Provider Business Mailing Address
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Address Line | PO BOX 531
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City | MT PLEASANT
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State | TX
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Zip | 75456-0531
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Country | US
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Telephone | 903-577-7700
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Fax | 903-577-7706
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY B. COLE
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Credential | M.D.
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Telephone | 903-577-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | E3237
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License Number State | TX
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