Provider Demographics
NPI:1841687274
Name:COLE, CONNOR O'NEILL (PA-C)
Entity type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:O'NEILL
Last Name:COLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UPPER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5730
Mailing Address - Country:US
Mailing Address - Phone:831-648-7200
Mailing Address - Fax:831-648-7204
Practice Address - Street 1:12 UPPER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5730
Practice Address - Country:US
Practice Address - Phone:831-648-7200
Practice Address - Fax:831-648-7204
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA58270OtherPHYSICIAN ASSISTANT LICENSE