Provider Demographics
NPI:1992748651
Name:COLE, TERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3418 LOMA VISTA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3016
Mailing Address - Country:US
Mailing Address - Phone:805-639-9510
Mailing Address - Fax:805-639-9515
Practice Address - Street 1:3418 LOMA VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3016
Practice Address - Country:US
Practice Address - Phone:805-639-9510
Practice Address - Fax:805-639-9515
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2023-11-02
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Provider Licenses
StateLicense IDTaxonomies
CAG29666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992748651Medicaid
CAWG29666BMedicare PIN
CAA44107Medicare UPIN