Provider Demographics
NPI:1396345534
Name:COTTER, WILLIAM III (DOM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:COTTER
Suffix:III
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 BALDWIN AVE # F-101
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7505
Mailing Address - Country:US
Mailing Address - Phone:808-572-2424
Mailing Address - Fax:
Practice Address - Street 1:3681 BALDWIN AVE # F-101
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-7505
Practice Address - Country:US
Practice Address - Phone:808-572-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-13171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist