Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 05-38440 | KS |
Y | 207PE0004X | Emergency Medical Services | 4059 | OK |
NPI | 1194705772 |
---|---|
Provider Name | Roger J Cotner |
First Address | Bartlesville, OK 74006 |
Second Address | Bartlesville, OK 74006-8448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 12/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200051200A | (05) | OK |
I28617 | (02) |