Provider Demographics
NPI:1336111665
Name:COLE, ANDREW AXLEY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:AXLEY
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2180 ADA AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6135
Mailing Address - Country:US
Mailing Address - Phone:501-327-6547
Mailing Address - Fax:501-327-9715
Practice Address - Street 1:2180 ADA AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6135
Practice Address - Country:US
Practice Address - Phone:501-327-6547
Practice Address - Fax:501-327-9715
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC8239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129346001Medicaid
BC3698086OtherDRUG ENFORCEMENT ADMINIST
5K053Medicare ID - Type Unspecified
AR129346001Medicaid