Provider Demographics
NPI:1770521858
Name:COTICCHIA, JAMES M (MD,)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:COTICCHIA
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-1575
Mailing Address - Fax:850-416-1426
Practice Address - Street 1:1675 TRINITY DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-416-1575
Practice Address - Fax:850-416-1426
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036172540207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11043425001Medicaid
MI0P30630042Medicare PIN