Provider Demographics
NPI:1215930144
Name:COLE, TIMOTHY B (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:B
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 1:7300 ELDORADO PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7891
Mailing Address - Country:US
Mailing Address - Phone:972-747-0440
Mailing Address - Fax:972-747-0441
Practice Address - Street 1:7300 ELDORADO PKWY
Practice Address - Street 2:SUITE 260
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7891
Practice Address - Country:US
Practice Address - Phone:972-747-0440
Practice Address - Fax:972-747-0441
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4052208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
460842838OtherTAX ID
894OtherMIDLANDS CHOICE
NE279730Medicare ID - Type Unspecified
01040OtherBCBS
5212532OtherAETNA
A003OtherTRICARE
203750273OtherTAX ID
NEG19021Medicare UPIN