Healthcare Provider Details

I. General information

NPI: 1972611481
Provider Name (Legal Business Name): BRADLEY KEVIN COOTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST FL 4
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

PO BOX 31001-4110
PASADENA CA
91110-4110
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5866
  • Fax: 406-329-5864
Mailing address:
  • Phone: 406-327-3199
  • Fax: 406-327-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number39703
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number27081
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number9162
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMED-PHYS-LIC-76243
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: