Provider Demographics
NPI:1124032008
Name:COLE, CHRISTOPHER BUNYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BUNYAN
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 1:142 N SEQUOIA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1058
Mailing Address - Country:US
Mailing Address - Phone:256-683-6400
Mailing Address - Fax:
Practice Address - Street 1:1005 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2454
Practice Address - Country:US
Practice Address - Phone:256-230-3061
Practice Address - Fax:256-230-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-103545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH52384Medicare UPIN