Provider Demographics
NPI:1912192204
Name:COLE, BRANDON COREY (RDMS, RVT, RNCST)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:COREY
Last Name:COLE
Suffix:
Gender:M
Credentials:RDMS, RVT, RNCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2072
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0036
Mailing Address - Country:US
Mailing Address - Phone:214-732-8165
Mailing Address - Fax:866-261-1293
Practice Address - Street 1:7552 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-3448
Practice Address - Country:US
Practice Address - Phone:214-732-8165
Practice Address - Fax:866-261-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCERTIFICATE 627AAET246ZE0600X
TX95167 ARDMS2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTVSC1Medicare PIN