Individual
MICHAEL PATRICK COTTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 740, FORT WORTH, TX 76104
(817) 250-2890
Mailing address
1325 PENNSYLVANIA AVE STE 740, FORT WORTH, TX 76104-2144
(817) 250-2890
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
04-31771
KS
208000000X
Pediatrics Physician
Q9138
TX
208M00000X
Hospitalist Physician
Primary
Q9138
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295755577
—
AL
05
—
200379560A
—
KS
01
—
KA2129004
MEDICARE PTAN
KS
Enumeration date
07/20/2006
Last updated
01/09/2019
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