Provider Demographics
NPI:1164482162
Name:COTNER, JAMES BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:COTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:BRIAN
Other - Last Name:COTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-0668
Mailing Address - Country:US
Mailing Address - Phone:479-754-9945
Mailing Address - Fax:479-754-9947
Practice Address - Street 1:601 W MCKENNON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3523
Practice Address - Country:US
Practice Address - Phone:479-754-8384
Practice Address - Fax:479-754-7141
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139786001Medicaid
AR5L434OtherARK BLUECROSS
H14803Medicare UPIN
5L434Medicare PIN
AR5L434OtherARK BLUECROSS