Provider Demographics
NPI:1629105275
Name:COTTRELL, RICHARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13787 BELCHER S RD 140
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:727-518-7294
Mailing Address - Fax:727-584-4937
Practice Address - Street 1:13787 BELCHER S RD 140
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4065
Practice Address - Country:US
Practice Address - Phone:727-518-7294
Practice Address - Fax:727-584-4937
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS81732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4952AMedicare ID - Type Unspecified