MEDICARE: DR. JASON WILLIAM COTTER 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	208600000X	Surgery Physician	200300326	NC
2	208600000X	Surgery Physician	TL31669	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801859640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON WILLIAM COTTER M.D.

Provider Business Mailing Address
First Line	:	75 BAYLOR DR
Second Line	:	SUITE 290
City	:	BLUFFTON
State	:	SC
Zip	:	29910-8965
Country	:	US
Telephone Number	:	843-705-8919
Fax Number	:	843-705-7024

Provider Business Practice Location Address
First Line	:	75 BAYLOR DR
Second Line	:	SUITE 290
City	:	BLUFFTON
State	:	SC
Zip	:	29910-8965
Country	:	US
Telephone Number	:	843-705-8919
Fax Number	:	843-705-7024

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/16/2014

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