Provider Demographics
NPI:1720079163
Name:COTTOM, JAMES M (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:COTTOM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 S TUTTLE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3108
Mailing Address - Country:US
Mailing Address - Phone:941-924-8777
Mailing Address - Fax:941-924-5888
Practice Address - Street 1:2030 BEE RIDGE RD
Practice Address - Street 2:STE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6108
Practice Address - Country:US
Practice Address - Phone:941-845-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-003432213ES0103X
MI5901002108213ES0103X
FLP03305213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7934680OtherAETNA
MI4856313290OtherBCBSM PIN#
MI17192OtherMCARE
MI4752569 TYPE 13Medicaid
FL340658000Medicaid
OH2643456Medicaid
MI4752578 TYPE 13Medicaid
MI4752578 TYPE 13Medicaid
MI17192OtherMCARE
MI7934680OtherAETNA
MI4856313290OtherBCBSM PIN#
OH2643456Medicaid
FL4818310001Medicare NSC