Provider Demographics
NPI:1356636609
Name:COLE, DYLAN (DO)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 WILLIAMS WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2065
Mailing Address - Country:US
Mailing Address - Phone:435-259-7121
Mailing Address - Fax:435-259-3112
Practice Address - Street 1:476 WILLIAMS WAY
Practice Address - Street 2:SUITE A
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2065
Practice Address - Country:US
Practice Address - Phone:435-259-7121
Practice Address - Fax:435-259-3112
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT9074848-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine