Provider Demographics
NPI:1114128568
Name:COLES, DONALD (DOM, AP, PA-C)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:COLES
Suffix:
Gender:M
Credentials:DOM, AP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 MIRAMAR PKWY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3937
Mailing Address - Country:US
Mailing Address - Phone:954-593-5524
Mailing Address - Fax:
Practice Address - Street 1:6049 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3937
Practice Address - Country:US
Practice Address - Phone:954-593-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1506171100000X
FLPA 9104805363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171100000XOther Service ProvidersAcupuncturist