Provider Demographics
NPI:1912938291
Name:COLES, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:COLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6528
Mailing Address - Country:US
Mailing Address - Phone:423-364-4112
Mailing Address - Fax:423-756-7247
Practice Address - Street 1:1012 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3993
Practice Address - Country:US
Practice Address - Phone:423-756-7246
Practice Address - Fax:423-756-7247
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023942208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000735501BMedicaid
GA000735501BMedicaid
TN3072760Medicare ID - Type Unspecified