Provider Demographics
NPI:1659368850
Name:COTTRILL, ERIC L (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:COTTRILL
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:PO BOX 700930
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74170-0930
Mailing Address - Country:US
Mailing Address - Phone:918-307-3144
Mailing Address - Fax:918-307-3145
Practice Address - Street 1:10505 E 91ST ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5801
Practice Address - Country:US
Practice Address - Phone:918-307-3144
Practice Address - Fax:918-307-3145
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13194207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100221630AMedicaid
OKC94802Medicare UPIN
OKOK700906Medicare PIN