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General NPI Number Information
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NPI Number | 1801199658
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Entity Type | Organization
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Legal Business Name | COTTONWOOD FAMILY PRACTICE PLLC
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 615 SW JENNINGS AVE BOX 2466
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City | BARTLESVILLE
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State | OK
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Zip | 74005-6602
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Country | US
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Telephone | 918-876-0495
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Fax | 918-213-4949
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Provider Business Mailing Address
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Address Line | PO BOX 2466
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City | BARTLESVILLE
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State | OK
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Zip | 74005-2466
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CRAIG S CORSON
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Credential | MD
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Telephone | 918-876-0495
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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 | 25161
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License Number State | OK
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