Provider Demographics
NPI:1306893151
Name:COTTRELL, WILLIAM C (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:COTTRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3395
Mailing Address - Country:US
Mailing Address - Phone:727-461-6026
Mailing Address - Fax:727-461-7446
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3395
Practice Address - Country:US
Practice Address - Phone:727-461-6026
Practice Address - Fax:727-461-7446
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME79229207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265049500Medicaid
FLME79229OtherLICENSE
FL15349ZMedicare PIN
FLME79229OtherLICENSE