Basic Information
| Provider Information | |||||||||
| NPI: | 1407230956 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROGER COLE MD, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4625 LINDELL BLVD | ||||||||
| Address2: | SUITE 507 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631083725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143674800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4625 LINDELL BLVD | ||||||||
| Address2: | SUITE 507 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631083725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143674800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 07/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | BARTO | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3143674800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 2011012589 | MO | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.