Provider Demographics
NPI:1790004554
Name:RUSSELL D COLE MD PC
Entity type:Organization
Organization Name:RUSSELL D COLE MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:D
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-880-6138
Mailing Address - Street 1:10300 BAILEY COVE RD SE
Mailing Address - Street 2:STE 13
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2635
Mailing Address - Country:US
Mailing Address - Phone:256-880-6138
Mailing Address - Fax:256-881-4619
Practice Address - Street 1:10300 BAILEY COVE RD SE
Practice Address - Street 2:STE 13
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2635
Practice Address - Country:US
Practice Address - Phone:256-880-6138
Practice Address - Fax:256-881-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD30120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty