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General NPI Number Information
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NPI Number | 1215913264
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Entity Type | Individual
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Provider Name | STEPHEN W COTLAR MD
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Gender | Male
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 2635 N 7TH ST
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-1628
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Country | US
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Telephone | 970-298-6307
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Fax | 970-298-7037
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Provider Business Mailing Address
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Address Line | PO BOX 62
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City | GRAND JUNCTION
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State | CO
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Zip | 81502-0062
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Country | US
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Telephone | 970-298-6307
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Fax | 970-298-7037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 43223
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | 43223
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License Number State | CO
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