Provider Demographics
NPI:1225249105
Name:COLE, PHILIP A II (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:COLE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3311 PRESCOTT RD STE 201
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3983
Mailing Address - Country:US
Mailing Address - Phone:318-442-6767
Mailing Address - Fax:318-441-1359
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-442-6767
Practice Address - Fax:318-441-1359
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA204473208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079341Medicaid