Healthcare Provider Details

I. General information

NPI: 1689311573
Provider Name (Legal Business Name): AARON KOTAMARTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E GRANT RD
TUCSON AZ
85712-2874
US

IV. Provider business mailing address

6526 COVECREEK PL
DALLAS TX
75240-5426
US

V. Phone/Fax

Practice location:
  • Phone: 214-649-7792
  • Fax:
Mailing address:
  • Phone: 214-649-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number80243
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: