Provider Demographics
NPI:1164853578
Name:BEWLEY, COLE (PA-C)
Entity type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:BEWLEY
Suffix:
Gender:M
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 1:2162 E WILLIAMS FIELD RD STE 111
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-0736
Mailing Address - Country:US
Mailing Address - Phone:480-795-1515
Mailing Address - Fax:480-597-1723
Practice Address - Street 1:2162 E WILLIAMS FIELD RD STE 111
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-0736
Practice Address - Country:US
Practice Address - Phone:480-795-1515
Practice Address - Fax:480-597-1723
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5617OtherAZ LICENSE
AZ874861Medicaid
AZZ164190Medicare PIN