Provider Demographics
NPI:1972505998
Name:COTTON, JAMES R (PAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:COTTON
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 COYLE AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0311
Mailing Address - Country:US
Mailing Address - Phone:916-965-4000
Mailing Address - Fax:916-965-4813
Practice Address - Street 1:6403 COYLE AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0311
Practice Address - Country:US
Practice Address - Phone:916-965-4000
Practice Address - Fax:916-965-4813
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA154980Medicare ID - Type Unspecified
CAP42919Medicare UPIN