Basic Information
| Provider Information | |||||||||
| NPI: | 1376824078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTTLE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1660 S STAPLES ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618008155 | ||||||||
| FaxNumber: | 3618822590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 S STAPLES ST | ||||||||
| Address2: | STE 150 | ||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784043173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618008155 | ||||||||
| FaxNumber: | 3618822590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2011 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP120846 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 264931YMVU | 01 | TX | WNI PTAN | OTHER |