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General NPI Number Information
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NPI Number | 1952439325
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Entity Type | Organization
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Legal Business Name | ED COTGAGEORGE PC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MERCADO SUITE 265
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City | DURANGO
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State | CO
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Zip | 81301
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Country | US
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Telephone | 970-259-4770
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Fax | 970-247-8502
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Provider Business Mailing Address
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Address Line | #1 MERCADO SUITE 265
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City | DURANGO
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State | CO
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Zip | 81301
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Country | US
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Telephone | 970-259-4770
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Fax | 970-247-8502
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Authorized Official
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Title or Position | OWNER
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Name | DR. ED COTGAGEORGE
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Credential | PH.D.
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Telephone | 970-259-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1831
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License Number State | CO
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