Provider Demographics
NPI:1558460345
Name:COTLAR, ALVIN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:MARTIN
Last Name:COTLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:924 SAVANNAH PLACE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507
Mailing Address - Country:US
Mailing Address - Phone:228-896-8720
Mailing Address - Fax:228-377-8066
Practice Address - Street 1:301 FISHER STREET
Practice Address - Street 2:
Practice Address - City:KEESLER AIR FORCE BASE
Practice Address - State:MS
Practice Address - Zip Code:39534-2519
Practice Address - Country:US
Practice Address - Phone:228-376-3083
Practice Address - Fax:228-377-8066
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS14642208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery