Provider Demographics
NPI:1093209090
Name:COLE, AUSTIN AXLEY (MD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:AXLEY
Last Name:COLE
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 1:5760 GRAND TETON LN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7623
Mailing Address - Country:US
Mailing Address - Phone:864-867-8111
Mailing Address - Fax:
Practice Address - Street 1:550 CLUB LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-3681
Practice Address - Country:US
Practice Address - Phone:501-329-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-11281207XX0005X
ARE-18048207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine