Provider Demographics
NPI:1194743260
Name:COTNEY, THOMAS WADE (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WADE
Last Name:COTNEY
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 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-793-5375
Mailing Address - Fax:325-793-5357
Practice Address - Street 1:1665 ANTILLEY RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5265
Practice Address - Country:US
Practice Address - Phone:325-695-7740
Practice Address - Fax:325-695-2540
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3864207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B2204OtherBLUE CROSS
TXP00302437OtherRAILROAD MEDICARE
TXP00302437OtherRAILROAD MEDICARE
TX8G2359Medicare ID - Type UnspecifiedMEDICARE
TX8G2359Medicare PIN