Provider Demographics
NPI:1376824078
Name:COTTLE, DAVID LEE
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:COTTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3173
Mailing Address - Country:US
Mailing Address - Phone:361-800-8155
Mailing Address - Fax:361-882-2590
Practice Address - Street 1:1660 S STAPLES ST
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3173
Practice Address - Country:US
Practice Address - Phone:361-800-8155
Practice Address - Fax:361-882-2590
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX264931YMVUOtherWNI PTAN