Provider Demographics
NPI:1689743734
Name:COLE, SIDNEY C (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:C
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 1:1905 CLINT MOORE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-2658
Mailing Address - Country:US
Mailing Address - Phone:561-241-8668
Mailing Address - Fax:561-912-9556
Practice Address - Street 1:1905 CLINT MOORE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496-2658
Practice Address - Country:US
Practice Address - Phone:561-241-8668
Practice Address - Fax:561-912-9556
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0012553207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0012553OtherSTATE LICENSE
06944ZMedicare ID - Type Unspecified
D51794Medicare UPIN