MEDICARE: WILLIAM F. COTHERN,D.O.,P.A.

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
1	207N00000X	Dermatology Physician	F9330	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00J14U	OTHER	TX	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1295034924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM F. COTHERN,D.O.,P.A.

Provider Business Mailing Address
First Line	:	4201 CAMP BOWIE BLVD
Second Line	:	STE. A
City	:	FT WORTH
State	:	TX
Zip	:	76107-3928
Country	:	US
Telephone Number	:	817-377-1243
Fax Number	:	817-763-0631

Provider Business Practice Location Address
First Line	:	4201 CAMP BOWIE BLVD
Second Line	:	STE. A
City	:	FT WORTH
State	:	TX
Zip	:	76107-3928
Country	:	US
Telephone Number	:	817-377-1243
Fax Number	:	817-763-0631

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. WILLIAM FORREST COTHERN
Credential	:	D.O.,P.A.
Telephone Number	:	817-377-1243

Provider Enumeration Date	:	03/21/2011
Last Update Date	:	03/21/2011

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Directions to “WILLIAM F. COTHERN,D.O.,P.A. ” Practice Location

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