Individual
MR. GARY MICHAEL COLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1508
Mailing address
4212 NORTH 16TH ST, PHOENIX, AZ 85016
(602) 263-1508
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
KA767
KS
Other
Enumeration date
04/09/2009
Last updated
04/09/2009
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