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General NPI Number Information
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NPI Number | 1811911829
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Entity Type | Individual
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Provider Name | CHARLES RAYMOND COTTRELL M D
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2400 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5314
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Country | US
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Telephone | 850-205-8404
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Fax | 850-216-1321
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Provider Business Mailing Address
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Address Line | 2400 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5314
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Country | US
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Telephone | 850-205-8404
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Fax | 850-216-1321
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME34034
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License Number State | FL
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