Provider Demographics
NPI:1780604793
Name:COLE, JOE L (MD, PA)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:L
Last Name:COLE
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2628
Mailing Address - Country:US
Mailing Address - Phone:210-930-0440
Mailing Address - Fax:
Practice Address - Street 1:8001 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2628
Practice Address - Country:US
Practice Address - Phone:210-930-0440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1464207RR0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0094PYOtherBCBS
TX171838901Medicaid
TX126481402OtherCOMMUNITY FIRT,
TX126481406OtherSUPERIOR, AETNA MCD & DR
TXDB8033OtherMEDICARE RAILROAD
TX00H24YOtherBCBS
TX126481401OtherCIDC
TX8B8281Medicare ID - Type Unspecified
TX171838901Medicaid