Provider Demographics
NPI:1164488185
Name:COTTAM, TAMARA O (MD)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:O
Last Name:COTTAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E. 18TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4797
Mailing Address - Country:US
Mailing Address - Phone:307-777-7911
Mailing Address - Fax:307-634-3510
Practice Address - Street 1:820 E. 17TH STREET
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4797
Practice Address - Country:US
Practice Address - Phone:307-777-7911
Practice Address - Fax:307-634-3510
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5711A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS23042OtherDEPT. HEALTH HUMAN SVCS.
WY313170OtherBLUE CROSS BLUE SHILED
WY111040300Medicaid
WYP00169593OtherRR MEDICARE
WYP00169593OtherRR MEDICARE
G15868Medicare UPIN
WYG15868Medicare UPIN