Individual
DR. COLE JOSEPH PANUSHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1433 N 1075 W STE 104, FARMINGTON, UT 84025-2746
(801) 298-1300
(801) 296-6199
Mailing address
PO BOX 25488, SALT LAKE CITY, UT 84125-0488
(800) 475-3698
(801) 296-6199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
1825061205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10058
—
UT
05
—
120889600
—
WY
05
—
807112800
—
ID
05
—
931718
—
AZ
01
—
P00199626
RR MEDICARE
UT
01
—
P00651556
RR MEDICARE
UT
Enumeration date
11/08/2005
Last updated
02/19/2019
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