Provider Demographics
NPI:1972502425
Name:COLE, CLIFTON (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
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 1:255 N EL CIELO RD
Mailing Address - Street 2:SUITE 140-701
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6992
Mailing Address - Country:US
Mailing Address - Phone:760-320-6677
Mailing Address - Fax:760-969-7238
Practice Address - Street 1:255 N EL CIELO RD
Practice Address - Street 2:SUITE 140-701
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6992
Practice Address - Country:US
Practice Address - Phone:760-320-6677
Practice Address - Fax:760-969-7238
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48556207Q00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
A51098Medicare UPIN