Provider Demographics
NPI:1659460384
Name:COLE, CRAIG A (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
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:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-0203
Mailing Address - Country:US
Mailing Address - Phone:337-457-8400
Mailing Address - Fax:337-457-8500
Practice Address - Street 1:1341 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3707
Practice Address - Country:US
Practice Address - Phone:337-457-8400
Practice Address - Fax:337-457-8500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13318174400000X, 208600000X
AL28812174400000X
LA17008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1952672Medicaid
AL1659460384Medicaid
MS00110709Medicaid
MS00110709Medicaid
AL1659460384Medicaid