Individual
DR. CHARLES E. COTTLE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4219 S WESTERN AVE, OKLAHOMA CITY, OK 73109-3410
(405) 644-5356
(405) 636-7946
Mailing address
5300 N INDEPENDENCE AVE STE 280, OKLAHOMA CITY, OK 73112-5555
(405) 644-5356
(405) 636-7946
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
34905
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1311425-05
—
TX
01
—
176783000
OWCP
TX
01
—
2221992
BLUE LINK
TX
01
—
250006941
MEDICARE R.R.
TX
01
—
4103577
AETNA
TX
Enumeration date
08/09/2006
Last updated
07/10/2019
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