Healthcare Provider Details

I. General information

NPI: 1669492641
Provider Name (Legal Business Name): MICHAEL BRIAN COTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 W NEWBERRY RD STE 508
GAINESVILLE FL
32605-8303
US

IV. Provider business mailing address

6440 W NEWBERRY RD STE 508
GAINESVILLE FL
32605-8303
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-2011
  • Fax: 352-384-3611
Mailing address:
  • Phone: 352-371-2011
  • Fax: 352-384-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0061235
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME61235
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME0061235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: