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Individual

MARK M. COTTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 412-5265
(318) 435-3842
Mailing address
2106 LOOP RD, WINNSBORO, LA 71295-3344
(318) 412-5265
(318) 435-3842

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
303027
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1962988
LA
01
5U045
MEDICARE PTAN
LA
Enumeration date
04/17/2013
Last updated
09/14/2016
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