Provider Demographics
NPI:1659484491
Name:COLE, JEFFREY ALLEN (DO)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALLEN
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 W MAIN ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1059
Mailing Address - Country:US
Mailing Address - Phone:207-564-4466
Mailing Address - Fax:207-564-4468
Practice Address - Street 1:891 W MAIN ST
Practice Address - Street 2:SUITE 700
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1059
Practice Address - Country:US
Practice Address - Phone:207-564-4466
Practice Address - Fax:207-564-4468
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N74390Medicare ID - Type Unspecified
H78238Medicare UPIN