=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407963432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GINA RACHELLE COTTLE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 11/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3944 RR 620 S BLDG 8 STE 222
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 125-263-1113
-----------------------------------------------------
Fax | 125-263-1119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3944 RR 620 S BLDG 8 STE 222
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78738-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 125-263-1113
-----------------------------------------------------
Fax | 125-263-1119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | M7304
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------