Healthcare Provider Details

I. General information

NPI: 1407963705
Provider Name (Legal Business Name): DONALD R COTTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 MCINTOSH CIRCLE
JOPLIN MO
64804-3649
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-4800
  • Fax: 417-347-4033
Mailing address:
  • Phone: 417-347-4800
  • Fax: 417-347-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR5211
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberR5211
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: