Provider Demographics
NPI:1659363067
Name:COTTER, GREGORY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:WILLIAM
Last Name:COTTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 ESSEN LN STE 500
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3738
Mailing Address - Country:US
Mailing Address - Phone:225-215-1142
Mailing Address - Fax:
Practice Address - Street 1:4950 ESSEN LN STE 500
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3738
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-767-1335
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC117732085R0001X
AL97732085R0001X
MS158292085R0001X
LA3082652085R0001X
TN477752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01073107OtherRR MEDICARE
MS00011136Medicaid
AL920002053OtherRR MEDICARE
AL000016332Medicaid
TN1528979Medicaid
MSP01134118OtherRR MEDICARE
TN4334897OtherBCBS TN
TN1528979Medicaid
AL000016332Medicare PIN
MSP01134118OtherRR MEDICARE
TN4334897OtherBCBS TN
AL000016332Medicare PIN