Provider Demographics
NPI:1972611481
Name:COOTS, BRADLEY KEVIN (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:KEVIN
Last Name:COOTS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31001-4110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-4110
Mailing Address - Country:US
Mailing Address - Phone:406-327-3199
Mailing Address - Fax:406-327-3332
Practice Address - Street 1:900 N ORANGE ST STE 205
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2951
Practice Address - Country:US
Practice Address - Phone:406-327-3199
Practice Address - Fax:406-327-3332
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD9162208200000X
IA397032086S0122X
NE270812086S0122X
MTMED-PHYS-LIC-76243208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery