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NPI Code Detail

MEDICARE: DEIDRE PAIGE HUEY COTA

MEDICARE: DEIDRE PAIGE HUEY COTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12083X0100XOccupational Medicine PhysicianOTA610AR

General Provider Information

NPI Number : 1083904718
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRE PAIGE HUEY COTA
Provider Business Mailing Address
First Line : 140 HEIFER CREEK RD
Second Line :
City : SPRINGFIELD
State : AR
Zip : 72157-9658
Country : US
Telephone Number : 501-354-1052
Fax Number :
Provider Business Practice Location Address
First Line : 711 AVIGNON DR
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-5120
Country : US
Telephone Number : 601-605-6777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 04/14/2011

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Directions to “ DEIDRE PAIGE HUEY COTA” Practice Location

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