Provider Demographics
NPI:1528677077
Name:MEYERS, COLE (PA)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:MEYERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2241 RENEE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-3590
Mailing Address - Country:US
Mailing Address - Phone:810-689-8074
Mailing Address - Fax:
Practice Address - Street 1:1231 PINE GROVE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3500
Practice Address - Country:US
Practice Address - Phone:810-985-4300
Practice Address - Fax:810-985-9320
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant