Provider Demographics
NPI:1346747763
Name:MCCARTY, COLE PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:PHILIP
Last Name:MCCARTY
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:PO BOX 112730
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2730
Mailing Address - Country:US
Mailing Address - Phone:352-273-9860
Mailing Address - Fax:352-294-8035
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3134
Practice Address - Country:US
Practice Address - Phone:352-273-9860
Practice Address - Fax:352-294-8035
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164435208100000X
ALMD.38919208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120195800Medicaid