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General NPI Number Information
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NPI Number | 1558334201
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Entity Type | Individual
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Provider Name | RONALD WADE COTTLE MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 103 S OWEN ST
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City | ELIZABETHTOWN
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State | NC
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Zip | 28337-8878
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Country | US
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Telephone | 910-862-2900
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Fax | 910-862-2900
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Provider Business Mailing Address
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Address Line | PO BOX 790
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City | WHITEVILLE
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State | NC
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Zip | 28472-0790
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Country | US
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Telephone | 910-641-0400
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Fax | 910-642-5929
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30015
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License Number State | NC
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