Individual
JESSE ALAN COTTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10583 W LAKE HAZEL RD, BOISE, ID 83709-6326
(208) 302-5950
(208) 302-5955
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-5950
(208) 302-5955
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1626
ID
Other
Enumeration date
09/13/2018
Last updated
09/13/2018
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