Basic Information
| Provider Information | |||||||||
| NPI: | 1669492641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COTTER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 W NEWBERRY RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326056605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523712011 | ||||||||
| FaxNumber: | 3523843611 | ||||||||
| Practice Location | |||||||||
| Address1: | 6400 W NEWBERRY RD | ||||||||
| Address2: | STE 207 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326056605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523712011 | ||||||||
| FaxNumber: | 3523843611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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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 | 174400000X | ME0061235 | FL | N | Other Service Providers | Specialist | 207V00000X | ME61235 | FL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | ME0061235 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 25070 | 01 | FL | BCBS | OTHER | 375062100 | 05 | FL | MEDICAID | 102266 | 01 | FL | AVMED | OTHER |