Provider Demographics
NPI:1497948202
Name:JOHN P COLE MD INC
Entity Type:Organization
Organization Name:JOHN P COLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:562-799-3630
Mailing Address - Street 1:3801 KATELLA AVENUE #416
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3350
Mailing Address - Country:US
Mailing Address - Phone:562-799-3630
Mailing Address - Fax:562-799-3634
Practice Address - Street 1:3801 KATELLA AVENUE #416
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3350
Practice Address - Country:US
Practice Address - Phone:562-799-3630
Practice Address - Fax:562-799-3634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25571207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A255711Medicaid
A24500Medicare UPIN
CA00A255711Medicaid