Provider Demographics
NPI:1194829432
Name:COTMAN, HENRY EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:EARL
Last Name:COTMAN
Suffix:
Gender:M
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33731-0383
Mailing Address - Country:US
Mailing Address - Phone:727-492-7335
Mailing Address - Fax:727-344-5005
Practice Address - Street 1:6449 38TH AVE N
Practice Address - Street 2:SUITE C-3
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1655
Practice Address - Country:US
Practice Address - Phone:727-492-7335
Practice Address - Fax:727-344-5005
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME198002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065598800Medicaid
FL19381OtherWELLCARE
62313OtherBC
4129335OtherAETNA
19381OtherHEALTHEASE MEDICAID
FL62313OtherHEALTH OPTIONS
D57400Medicare UPIN
FL19381OtherWELLCARE