Provider Demographics
NPI:1023074044
Name:COTNER, EDWARD S (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:COTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 VENTURA BLVD
Mailing Address - Street 2:#414
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2717
Mailing Address - Country:US
Mailing Address - Phone:818-990-7769
Mailing Address - Fax:818-906-1859
Practice Address - Street 1:1328 TWENTY SECOND STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2091
Practice Address - Country:US
Practice Address - Phone:310-582-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80494207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A804940Medicaid
CA00A804940Medicaid
I34981Medicare UPIN