Provider Demographics
NPI:1386767630
Name:COLE, GARY W (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20271 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5322
Mailing Address - Country:US
Mailing Address - Phone:714-968-0720
Mailing Address - Fax:
Practice Address - Street 1:DEPT. OF DERMATOLOGY, UNIV. OF CALIF., IRVINE
Practice Address - Street 2:MEDICAL SCIENCES 1, RM C340
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697
Practice Address - Country:US
Practice Address - Phone:949-824-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG27624207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG27624AMedicare PIN