Healthcare Provider Details

I. General information

NPI: 1861811085
Provider Name (Legal Business Name): JEFFREY COTTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 N RIDGE RD
WICHITA KS
67205-1227
US

IV. Provider business mailing address

3730 N RIDGE RD STE 100
WICHITA KS
67205-1228
US

V. Phone/Fax

Practice location:
  • Phone: 316-462-6200
  • Fax:
Mailing address:
  • Phone: 316-462-6200
  • Fax: 316-462-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR-11701
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-46258
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: