Provider Demographics
NPI:1952407926
Name:COLES, JOSEPH GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GREGORY
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 1:90 MDG
Mailing Address - Street 2:6900 ALDEN DR.
Mailing Address - City:FE WARREN AFB
Mailing Address - State:WY
Mailing Address - Zip Code:82001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90TH MDG
Practice Address - Street 2:6900 ALDEN DR
Practice Address - City:FE WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005
Practice Address - Country:US
Practice Address - Phone:307-773-2998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0916432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry