Provider Demographics
NPI:1093868127
Name:COLE, JAMES WEBB III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WEBB
Last Name:COLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DRAGONFLY DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-2584
Mailing Address - Country:US
Mailing Address - Phone:772-971-3829
Mailing Address - Fax:
Practice Address - Street 1:101 DRAGONFLY DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-2584
Practice Address - Country:US
Practice Address - Phone:772-971-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 550852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062071800MedicaidMEDICAID PROVIDER NUMBER