Provider Demographics
NPI:1205476975
Name:COLE, DAVID S
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 E JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-0362
Mailing Address - Country:US
Mailing Address - Phone:480-699-4496
Mailing Address - Fax:
Practice Address - Street 1:4344 E JUANITA AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-0362
Practice Address - Country:US
Practice Address - Phone:480-699-4496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor