=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033307285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARRY COTLER INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23421 WALDEN CENTER DR. STE. 100
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34134-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-444-0700
-----------------------------------------------------
Fax | 239-444-0900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 799
-----------------------------------------------------
City | ESTERO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33929-0799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-398-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | HARRY COTLER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 239-444-0700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | PO3942
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------