Provider Demographics
NPI:1639366511
Name:J DEAN COLE MD LLC
Entity Type:Organization
Organization Name:J DEAN COLE MD LLC
Other - Org Name:J DEAN COLE MD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-895-8890
Mailing Address - Street 1:2501 N ORANGE AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-895-8890
Mailing Address - Fax:407-895-3608
Practice Address - Street 1:2501 N ORANGE AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-895-8890
Practice Address - Fax:407-895-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1013Medicare PIN