Provider Demographics
NPI:1114100559
Name:COLE, JEFFREY RANDALL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RANDALL
Last Name:COLE
Suffix:
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 1:323 MEDICAL CENTER DR SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3420
Mailing Address - Country:US
Mailing Address - Phone:256-273-4300
Mailing Address - Fax:
Practice Address - Street 1:323 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3420
Practice Address - Country:US
Practice Address - Phone:256-273-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAN3187956-S48208600000X
KY43830208600000X
ALMD31787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery