=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922300425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AJ COTTINGHAM JR MD ,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2010
-----------------------------------------------------
Last Update Date | 12/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15900 LA CANTERA PKWY SUITE 19205
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78256-2422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-696-0101
-----------------------------------------------------
Fax | 210-695-8172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15900 LA CANTERA PKWY SUITE 19205
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-696-0101
-----------------------------------------------------
Fax | 210-695-8172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPHTHALOMOGIST
-----------------------------------------------------
Name | DR. ANDREW JACKSON COTTINGHAM JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-696-0101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | G7466
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------