Provider Demographics
NPI:1801199658
Name:COTTONWOOD FAMILY PRACTICE PLLC
Entity Type:Organization
Organization Name:COTTONWOOD FAMILY PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-876-0495
Mailing Address - Street 1:PO BOX 2466
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74005-2466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 SW JENNINGS AVE
Practice Address - Street 2:BOX 2466
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74005-6602
Practice Address - Country:US
Practice Address - Phone:918-876-0495
Practice Address - Fax:918-213-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25161207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty