Provider Demographics
NPI:1386793214
Name:COLE, PHILLIP ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3637 MISSION AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-679-3524
Mailing Address - Fax:916-488-7432
Practice Address - Street 1:77 CADILLAC DR
Practice Address - Street 2:SUITE 210
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-5453
Practice Address - Country:US
Practice Address - Phone:916-325-1040
Practice Address - Fax:916-669-4100
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA94371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADK563ZMedicare PIN