Provider Demographics
NPI:1679549984
Name:COLE, ROBERT DALE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4818 NW 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2189
Mailing Address - Country:US
Mailing Address - Phone:903-654-0653
Mailing Address - Fax:
Practice Address - Street 1:4818 NW 58TH AVE
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-2189
Practice Address - Country:US
Practice Address - Phone:903-654-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126320207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y226OtherMEDICARE GROUP
TXP00463094OtherRAILROAD MEDICARE
TXDG9311OtherRAILROAD MEDICARE GROUP
TX039387803Medicaid
TXP00463094OtherRAILROAD MEDICARE
TX039387803Medicaid