Provider Demographics
NPI:1841234721
Name:COLE, CHRISTOPHER STANLEY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STANLEY
Last Name:COLE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:401 N WICKHAM RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8659
Mailing Address - Country:US
Mailing Address - Phone:321-242-9031
Mailing Address - Fax:321-242-9035
Practice Address - Street 1:401 N WICKHAM RD
Practice Address - Street 2:SUITE S
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8659
Practice Address - Country:US
Practice Address - Phone:321-242-9031
Practice Address - Fax:321-242-9035
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2009-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q04135Medicare UPIN