Provider Demographics
NPI:1609984152
Name:COTTER, CLEMENT P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:P
Last Name:COTTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1216 1ST ST N
Mailing Address - Street 2:HWY 31
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8702
Mailing Address - Country:US
Mailing Address - Phone:205-664-4630
Mailing Address - Fax:205-664-4658
Practice Address - Street 1:1216 1ST ST N
Practice Address - Street 2:HWY 31
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8702
Practice Address - Country:US
Practice Address - Phone:205-664-4630
Practice Address - Fax:205-664-4658
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00010998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51535894OtherBCBS OF ALABAMA
AL51535894OtherBCBS OF ALABAMA