Provider Demographics
NPI:1013911908
Name:COTTON, MARK W (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:COTTON
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 1:5610 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9635
Mailing Address - Country:US
Mailing Address - Phone:580-536-6600
Mailing Address - Fax:580-536-2427
Practice Address - Street 1:5610 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9635
Practice Address - Country:US
Practice Address - Phone:580-536-6600
Practice Address - Fax:580-536-2427
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100101580BMedicaid
F74258Medicare UPIN
OK$$$$$$$$$Medicare PIN
OK100101580BMedicaid