Provider Demographics
NPI:1083881098
Name:COLE, JON BUTZER (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:BUTZER
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:914 S 8TH ST
Mailing Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1210
Mailing Address - Country:US
Mailing Address - Phone:612-873-3044
Mailing Address - Fax:612-630-8242
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:HENNEPIN COUNTY MEDICAL CENTER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-3044
Practice Address - Fax:612-630-8242
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2009-10-13
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Provider Licenses
StateLicense IDTaxonomies
MN51680207P00000X
WI53484-020207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN19584OtherRESIDENCY PERMIT NUMBER