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General NPI Number Information
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NPI Number | 1306197595
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Entity Type | Organization
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Legal Business Name | MARK W. COTTON, D.O.
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Dates
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Enumeration Date | 09/27/2012
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 5610 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-9635
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Country | US
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Telephone | 580-536-6600
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Fax | 580-536-2427
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Provider Business Mailing Address
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Address Line | 5610 SW LEE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-9635
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Country | US
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Telephone | 580-536-6600
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Fax | 580-536-2427
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Authorized Official
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Title or Position | SUPERVISING PHYSICIAN
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Name | MARK W COTTON
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Credential | D.O.
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Telephone | 580-536-6600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 3005
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License Number State | OK
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