Provider Demographics
NPI:1407964109
Name:COLE, REX WALTON (MD)
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:WALTON
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1300 WONDER WORLD DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7575
Mailing Address - Country:US
Mailing Address - Phone:512-353-1300
Mailing Address - Fax:512-353-5135
Practice Address - Street 1:1300 WONDER WORLD DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7575
Practice Address - Country:US
Practice Address - Phone:512-353-1300
Practice Address - Fax:512-353-5135
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD2397207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120124601Medicaid
TX85X690OtherBCBS
TX742732278OtherTAX ID
TXC14619Medicare UPIN
TX120124601Medicaid