Basic Information
| Provider Information | |||||||||
| NPI: | 1376525667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COTIAUX | ||||||||
| FirstName: | GERTRUDE | ||||||||
| MiddleName: | PO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT STE 212 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976306 | ||||||||
| FaxNumber: | 8647976306 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 BOILING SPRINGS RD STE A | ||||||||
| Address2: | |||||||||
| City: | BOILING SPRINGS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293165304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645990731 | ||||||||
| FaxNumber: | 8645990791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-06-7352-C | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 39086 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2182043 | 05 | OH | MEDICAID |