Provider Demographics
NPI:1215997978
Name:COTTEN, DANIEL W (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:COTTEN
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 1445
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1445
Mailing Address - Country:US
Mailing Address - Phone:866-388-2916
Mailing Address - Fax:855-388-4124
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-977-5567
Practice Address - Fax:865-980-4962
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN199492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64720824Medicaid
TN300125492OtherRR MEDICARE
TN40222337OtherBC/BS OF TN
TN3074299Medicaid
TN40222337OtherBC/BS OF TN
TNF53797Medicare UPIN
TN3074299Medicaid