Provider Demographics
NPI:1437265642
Name:COTTON, FRED JUNIOR (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:JUNIOR
Last Name:COTTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1607 RIDGEMONT DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-1504
Mailing Address - Country:US
Mailing Address - Phone:940-692-4883
Mailing Address - Fax:
Practice Address - Street 1:1301 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4240
Practice Address - Country:US
Practice Address - Phone:940-549-3400
Practice Address - Fax:214-712-2487
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3082207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21991Medicare UPIN