Provider Demographics
NPI:1154364248
Name:COLE, PHILIP A (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:A
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1801 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4443
Mailing Address - Country:US
Mailing Address - Phone:318-424-8373
Mailing Address - Fax:318-424-6477
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-424-8373
Practice Address - Fax:318-424-6477
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA012262208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D79797Medicare UPIN
LA1193623Medicare ID - Type Unspecified
52096Medicare ID - Type Unspecified