Provider Demographics
NPI:1043274632
Name:COLE, ROBERT ELI (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELI
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:#302
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-829-4469
Mailing Address - Fax:310-829-0891
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:#302
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-829-4469
Practice Address - Fax:310-829-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG60151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E97866Medicare UPIN