Provider Demographics
NPI:1861578767
Name:COTTER OB/GYN ASSOCIATES
Entity type:Organization
Organization Name:COTTER OB/GYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-371-2011
Mailing Address - Street 1:720 SW 2ND AVE STE 466
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-1215
Mailing Address - Country:US
Mailing Address - Phone:352-371-2011
Mailing Address - Fax:352-384-3611
Practice Address - Street 1:720 SW 2ND AVE STE 466
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-1215
Practice Address - Country:US
Practice Address - Phone:352-371-2011
Practice Address - Fax:352-384-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF77427Medicare UPIN
FL25070Medicare ID - Type Unspecified