Provider Demographics
NPI:1396036463
Name:HOUSTON, COLE JACKSON (MD)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:JACKSON
Last Name:HOUSTON
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 1:4033 3RD AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2140
Mailing Address - Country:US
Mailing Address - Phone:888-883-8658
Mailing Address - Fax:888-606-1317
Practice Address - Street 1:4033 3RD AVE STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2140
Practice Address - Country:US
Practice Address - Phone:888-883-8658
Practice Address - Fax:888-606-1317
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148047207Q00000X
TN51823207P00000X, 207Q00000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program