Provider Demographics
NPI:1407963432
Name:COTTLE, GINA RACHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:RACHELLE
Last Name:COTTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:COTTLE
Other - Last Name:JAYAWANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3944 RR 620 S BLDG 8 STE 222
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-7000
Mailing Address - Country:US
Mailing Address - Phone:125-263-1113
Mailing Address - Fax:125-263-1119
Practice Address - Street 1:3944 RR 620 S BLDG 8 STE 222
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-7000
Practice Address - Country:US
Practice Address - Phone:125-263-1113
Practice Address - Fax:125-263-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7304207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S5182OtherBCBS OF TEXAS INDIVIDUAL #
TX189952801Medicaid
TX189952801Medicaid
TX8K1302Medicare PIN