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Individual

MR. SPENCER HERBERT COLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPAS, PA-C

Contact information

Practice address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(659) 301-0655
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(659) 301-0655

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
100752
NC
363A00000X
Physician Assistant
Primary
PA1705
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100228080
KY
Enumeration date
08/13/2012
Last updated
05/12/2015
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