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General NPI Number Information
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NPI Number | 1558460345
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Entity Type | Individual
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Provider Name | ALVIN MARTIN COTLAR MD
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 FISHER STREET
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City | KEESLER AIR FORCE BASE
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State | MS
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Zip | 39534-2519
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Country | US
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Telephone | 228-376-3083
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Fax | 228-377-8066
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Provider Business Mailing Address
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Address Line | 924 SAVANNAH PLACE
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City | GULFPORT
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State | MS
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Zip | 39507
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Country | US
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Telephone | 228-896-8720
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Fax | 228-377-8066
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 14642
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License Number State | MS
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