Provider Demographics
NPI:1578560207
Name:COLES, MAXIME JEAN-MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIME
Middle Name:JEAN-MARIE
Last Name:COLES
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 1176
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0919
Mailing Address - Country:US
Mailing Address - Phone:620-251-3838
Mailing Address - Fax:620-251-0736
Practice Address - Street 1:1411 W 4TH ST
Practice Address - Street 2:BUILDING C
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3300
Practice Address - Country:US
Practice Address - Phone:620-251-3838
Practice Address - Fax:620-251-0736
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31291207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
269-384-4OtherECFMG
MO2003025339OtherMEDICAL LICENSE
KS04-31291OtherMEDICAL LICENSE
CT26249OtherMEDICAL LICENSE
CT26249OtherMEDICAL LICENSE