Provider Demographics
NPI:1114695467
Name:COLE, BEAL W JR
Entity Type:Individual
Prefix:MR
First Name:BEAL
Middle Name:W
Last Name:COLE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 W WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-1531
Mailing Address - Country:US
Mailing Address - Phone:330-814-1397
Mailing Address - Fax:
Practice Address - Street 1:1061 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-1531
Practice Address - Country:US
Practice Address - Phone:330-814-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver