Provider Demographics
NPI:1144300666
Name:COLES, CHESTER CHATTIN JR (MD)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:CHATTIN
Last Name:COLES
Suffix:JR
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 1:5937 GOODWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7308
Mailing Address - Country:US
Mailing Address - Phone:225-928-8600
Mailing Address - Fax:
Practice Address - Street 1:5937 GOODWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7308
Practice Address - Country:US
Practice Address - Phone:225-928-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0122632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1170950Medicaid
LA51900Medicare ID - Type Unspecified
B63457Medicare UPIN