Provider Demographics
NPI:1639114507
Name:COLES, DONALD GLEN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:GLEN
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 1:11000 HEFNER POINTE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-5039
Mailing Address - Country:US
Mailing Address - Phone:405-749-9655
Mailing Address - Fax:405-749-1001
Practice Address - Street 1:11000 HEFNER POINTE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-5039
Practice Address - Country:US
Practice Address - Phone:405-749-9655
Practice Address - Fax:405-749-1001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16641208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0784740001OtherDMERC REGION C
F27272Medicare UPIN