Provider Demographics
NPI:1144223256
Name:COLE, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:901-259-1600
Mailing Address - Fax:901-259-1698
Practice Address - Street 1:6286 BRIARCREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-259-1600
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-7432207X00000X, 207XS0106X
TN21078207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN620819926OtherCIGNA
TN3058082Medicaid
TN620819926OtherAETNA
TN5826093OtherAETNA
TN620819926OtherTRICARE
MS620819926OtherBCBS
MS7187860Medicaid
TN8959498OtherCIGNA
TN3371161Medicaid
TN3040325OtherBCBS
MS000118678Medicaid
AR110318002Medicaid
AR129321001Medicaid
TN200025122OtherRAILROAD MEDICARE
MS620819926OtherBCBS
TN5826093OtherAETNA
MS7187860Medicaid