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General NPI Number Information
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NPI Number | 1972611481
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Entity Type | Individual
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Provider Name | BRADLEY KEVIN COOTS MD
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Gender | Male
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST FL 4
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-329-5866
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Fax | 406-329-5864
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone | 406-327-3199
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Fax | 406-327-3332
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 39703
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 27081
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 9162
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MED-PHYS-LIC-76243
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License Number State | MT
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