Basic Information
| Provider Information | |||||||||
| NPI: | 1386832970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | CHAD | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC10 5615 | ||||||||
| Address2: | 1 UNVIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 105951530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052723401 | ||||||||
| FaxNumber: | 5052726091 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871311530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052720621 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2007 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD2020-0136 | NM | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 55955 | WI | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 294901-1205 | UT | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 290897-1 | NY | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.