Provider Demographics
NPI:1164853578
Name:BEWLEY, COLE (PA-C)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:BEWLEY
Suffix:
Gender:M
Credentials: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:PO BOX 1117
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-1117
Mailing Address - Country:US
Mailing Address - Phone:480-616-0016
Mailing Address - Fax:602-688-2342
Practice Address - Street 1:2745 S. ALMA SCHOOL RD. STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286
Practice Address - Country:US
Practice Address - Phone:480-717-0356
Practice Address - Fax:480-616-0603
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ874861Medicaid
AZ5617OtherAZ LICENSE
AZZ164190Medicare PIN