Provider Demographics
NPI:1447357413
Name:COLE, DUSTIN M (MD)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
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:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-0912
Mailing Address - Country:US
Mailing Address - Phone:970-625-6555
Mailing Address - Fax:706-254-9899
Practice Address - Street 1:501 AIRPORT RD FL 2
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-8510
Practice Address - Country:US
Practice Address - Phone:706-625-1100
Practice Address - Fax:970-625-2752
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00515992081P2900X, 208100000X
AZ42958207LP2900X
MN50791208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1757Medicaid
MN250000807Medicare PIN