Provider Demographics
NPI:1699084467
Name:COLE, GARY WAYNE (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:580-977-1901
Mailing Address - Fax:580-249-4350
Practice Address - Street 1:620 S MADISON ST STE 108
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7270
Practice Address - Country:US
Practice Address - Phone:580-977-1901
Practice Address - Fax:580-249-4350
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2018-04-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK4891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200401470BMedicaid
OK567685YMXAMedicare PIN