Provider Demographics
NPI:1194804211
Name:COTTRELL, EARL DAVID (MD)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:DAVID
Last Name:COTTRELL
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 1:7200 W CATHEDRAL ROCK DR STE #130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-228-8600
Mailing Address - Fax:702-228-8689
Practice Address - Street 1:7200 W CATHEDRAL ROCK DR STE #130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-228-8600
Practice Address - Fax:702-228-8689
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV66422086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1194804211OtherNPI
NV100503250Medicaid
NV39180Medicare PIN
NVV39180Medicare PIN