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NPI Code Detail

MEDICARE: JOHN COTTAM MD PA

MEDICARE: JOHN COTTAM MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215603337
Entity Type Code : Organization
Provider Name (Legal Business Name) : JOHN COTTAM MD PA
Provider Business Mailing Address
First Line : 14310 N DALE MABRY HWY STE 180
Second Line :
City : TAMPA
State : FL
Zip : 33618-2059
Country : US
Telephone Number : 813-962-4210
Fax Number : 813-962-0566
Provider Business Practice Location Address
First Line : 5105 MANATEE AVE W STE 12
Second Line :
City : BRADENTON
State : FL
Zip : 34209-3706
Country : US
Telephone Number : 941-744-2454
Fax Number : 813-962-0566
Authorized Official
Title or Position : BILLING MANAGER
Name : SHAWNA FRAME
Credential :
Telephone Number : 423-525-5993
Provider Enumeration Date : 08/18/2021
Last Update Date : 07/13/2022

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