Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | K0010 | TX |
NPI | 1003893819 |
---|---|
Provider Name | Andrew J. Cottingham III |
First Address | Rapid City, SD 57702-7782 |
Second Address | Fort Meade, SD 57741-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 26/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050090073 | RAILROAD (01) | TX |
106190503 | (05) | TX |
106190505 | (05) | TX |
8G2123 | BCBS (01) | TX |
F43877 | (02) |