Provider Demographics
NPI:1962451807
Name:COLE, JEAN PAICURICH (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:PAICURICH
Last Name:COLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MEDICAL PARKWAY, BLDG B, STE 419
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5015
Mailing Address - Country:US
Mailing Address - Phone:512-528-7385
Mailing Address - Fax:512-528-7386
Practice Address - Street 1:1401 MEDICAL PARKWAY, BLDG B, STE 419
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5015
Practice Address - Country:US
Practice Address - Phone:512-528-7385
Practice Address - Fax:512-528-7386
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144728602Medicaid
TXH41764Medicare UPIN
TX8D9327Medicare ID - Type Unspecified