Provider Demographics
NPI:1578558441
Name:COLE, RICHARD CLINTON (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLINTON
Last Name:COLE
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 1:2106 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2208
Mailing Address - Country:US
Mailing Address - Phone:931-455-2045
Mailing Address - Fax:931-455-9960
Practice Address - Street 1:2106 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2208
Practice Address - Country:US
Practice Address - Phone:931-455-2045
Practice Address - Fax:931-455-9960
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3145745Medicaid
TN3707865Medicaid
TN3145745OtherBLUE CROSS BLUE SHIELD TN
TN3145745OtherBLUE CROSS BLUE SHIELD TN
TN3707865Medicaid