Provider Demographics
NPI:1952439325
Name:ED COTGAGEORGE PC
Entity Type:Organization
Organization Name:ED COTGAGEORGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:COTGAGEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-259-4770
Mailing Address - Street 1:#1 MERCADO SUITE 265
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-259-4770
Mailing Address - Fax:970-247-8502
Practice Address - Street 1:1 MERCADO SUITE 265
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-4770
Practice Address - Fax:970-247-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1831103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty