MEDICARE: DR. CHERILYNNE TONI COTTLES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD.016920	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346209921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERILYNNE TONI COTTLES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7422
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-0422
Country	:	US
Telephone Number	:	504-259-4541
Fax Number	:	318-356-9546

Provider Business Practice Location Address
First Line	:	1640 BREAZEALE SPRINGS ST
Second Line	:
City	:	NATCHITOCHES
State	:	LA
Zip	:	71457-4278
Country	:	US
Telephone Number	:	318-352-9299
Fax Number	:	318-356-9546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	07/08/2007

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