Organization
COTTLE MEDICAL GROUP PA
Active
Other names
Elizabethtown Family Physician
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD WADE COTTLE MD (PRESIDENT)
(910) 862-2900
Entity
Organization
Contact information
Practice address
103 S OWEN STREET, ELIZABETHTOWN, NC 28337
(910) 862-2900
(910) 862-2982
Mailing address
PO BOX 790, WHITEVILLE, NC 28472-0790
(910) 641-0400
(910) 642-5929
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30015
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017XT
BCBS OF NC
NC
05
—
7924670
—
NC
Enumeration date
09/13/2006
Last updated
04/05/2012
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