Healthcare Provider Details

I. General information

NPI: 1669412730
Provider Name (Legal Business Name): JEFFREY H KOTZEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4280 PROFESSIONAL CENTER DR SUITE 300
PALM BEACH GARDENS FL
33410-4280
US

IV. Provider business mailing address

4280 PROFESSIONAL CENTER DR SUITE 300
PALM BEACH GARDENS FL
33410-4280
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-2889
  • Fax: 561-748-1523
Mailing address:
  • Phone: 561-748-2889
  • Fax: 561-748-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME39811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: