MEDICARE: ERIC L COTTRILL M.D.

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
1	207RG0100X	Gastroenterology Physician	13194	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659368850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC L COTTRILL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 700930
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74170-0930
Country	:	US
Telephone Number	:	918-307-3144
Fax Number	:	918-307-3145

Provider Business Practice Location Address
First Line	:	10505 E 91ST ST
Second Line	:	SUITE 200
City	:	TULSA
State	:	OK
Zip	:	74133-5801
Country	:	US
Telephone Number	:	918-307-3144
Fax Number	:	918-307-3145

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/05/2010

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Directions to “ ERIC L COTTRILL M.D.” Practice Location

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