Provider Demographics
NPI:1811994668
Name:COTTERELL, LOUIS WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:WILLIAM
Last Name:COTTERELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-0302
Mailing Address - Country:US
Mailing Address - Phone:360-414-2727
Mailing Address - Fax:360-414-2739
Practice Address - Street 1:1615 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2310
Practice Address - Country:US
Practice Address - Phone:360-414-2727
Practice Address - Fax:360-414-2739
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025332207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110238251OtherRR MEDICARE
OR286784Medicaid
WA8936701OtherCRIME VICTIMS
WA8125916Medicaid
WA0158802OtherLABOR & IND.
WA8936701OtherCRIME VICTIMS
E69780Medicare UPIN