Healthcare Provider Details

I. General information

NPI: 1144201450
Provider Name (Legal Business Name): NUCLEAR STUDIES OF SOUTH FLORIDA,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5458 TOWN CENTER RD SUITE 103
BOCA RATON FL
33486-1089
US

IV. Provider business mailing address

PO BOX 11697
FT LAUDERDALE FL
33339-1697
US

V. Phone/Fax

Practice location:
  • Phone: 561-347-8077
  • Fax: 561-347-7731
Mailing address:
  • Phone: 561-347-8077
  • Fax: 561-347-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. JON ALLEN KOTLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 561-347-8077