Healthcare Provider Details

I. General information

NPI: 1215206792
Provider Name (Legal Business Name): KOZHIMALA T. JOHN M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 FORT KING RD
ZEPHYRHILLS FL
33542
US

IV. Provider business mailing address

PO BOX 1617
ZEPHYRHILLS FL
33539-1617
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-6116
  • Fax: 813-780-1051
Mailing address:
  • Phone: 813-782-6116
  • Fax: 813-780-1051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME23148
License Number StateFL

VIII. Authorized Official

Name: DR. KOZHIMALA T JOHN
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 813-782-6116