MEDICARE: DYAN COLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G67490	CA
2	207Q00000X	Family Medicine Physician	TP00979	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225067812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYAN COLE MD

Provider Business Mailing Address
First Line	:	3517 SUNSET LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-4358
Country	:	US
Telephone Number	:	805-746-2781
Fax Number	:

Provider Business Practice Location Address
First Line	:	3517 SUNSET LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93035-4358
Country	:	US
Telephone Number	:	805-746-2781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/17/2025

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Directions to “ DYAN COLE MD” Practice Location

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