Healthcare Provider Details

I. General information

NPI: 1356432090
Provider Name (Legal Business Name): FRANK R KOHLER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 N CLYDE MORRIS BLVD STE 2
DAYTONA BEACH FL
32117-5500
US

IV. Provider business mailing address

1667 N CLYDE MORRIS BLVD. SUITE 2
DAYTONA BEACH FL
32117-5550
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-4840
  • Fax:
Mailing address:
  • Phone: 386-274-4840
  • Fax: 386-274-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberOS14477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: