MEDICARE: TYLER CARAWAN COTA

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	261QX0100X	Occupational Medicine Clinic/Center	324708	CO

General Provider Information

NPI Number	:	1902223506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER CARAWAN COTA

Provider Business Mailing Address
First Line	:	2241 QUITMAN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80212-1115
Country	:	US
Telephone Number	:	303-928-0891
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 DOWNING ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5234
Country	:	US
Telephone Number	:	303-861-4825
Fax Number	:

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

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	03/21/2014

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