Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | LL 29020 | SC |
Y | 207P00000X | Emergency Physician | N3571 | TX |
N | 207P00000X | Emergency Physician | TEMP MED LICENSE | TX |
NPI | 1003947961 |
---|---|
Provider Name | Shane Parker Cole |
First Address | Oklahoma City, OK 73196-0349 |
Second Address | Arlington, TX 76017-5851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 22/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204092501 | (05) | TX |
204092502 | (05) | TX |
8BT331 | BCBS TX (01) | TX |
P00791718 | RR MCARE THRU SAEMA (01) | |
P00834182 | RR MCARE THRU AEMA (01) |