Provider Demographics
NPI:1194705772
Name:COTNER, ROGER J (DO)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:J
Last Name:COTNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006
Mailing Address - Country:US
Mailing Address - Phone:918-333-7200
Mailing Address - Fax:918-331-1091
Practice Address - Street 1:4200 SE ADAMS RD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8448
Practice Address - Country:US
Practice Address - Phone:918-978-4275
Practice Address - Fax:918-214-8051
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-38440207P00000X
OK4059207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051200AMedicaid
OK200051200AMedicaid
I28617Medicare UPIN