Healthcare Provider Details

I. General information

NPI: 1902033566
Provider Name (Legal Business Name): NATHAN KOHLER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5153 N 9TH AVE STE 302
PENSACOLA FL
32504
US

IV. Provider business mailing address

PO BOX 2699
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2250
  • Fax: 850-416-2536
Mailing address:
  • Phone: 850-416-2250
  • Fax: 850-416-2536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME109988
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: