Individual
JACK MARTIN COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15903
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
159036
—
SC
01
—
P01397050
RAILROAD MEDICARE
SC
01
—
SCJ0085019
MEDICARE PIN
SC
01
—
SCJ0085121
MEDICARE PIN
SC
01
—
SCJ0086067
MEDICARE PIN
SC
01
—
SCJ0086084
MEDICARE PIN
SC
01
—
SCJ0086633
MEDICARE PIN
SC
01
—
SCJ008J577
MEDICARE PIN
SC
Enumeration date
05/18/2006
Last updated
05/07/2021
Update your record
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