Provider Demographics
NPI:1922196708
Name:COLE, JAIME R (PA-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:R
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16760 W HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7400
Mailing Address - Country:US
Mailing Address - Phone:785-845-4501
Mailing Address - Fax:
Practice Address - Street 1:5605 W EUGIE AVE STE 110
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1273
Practice Address - Country:US
Practice Address - Phone:623-847-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ3559363A00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant