Healthcare Provider Details

I. General information

NPI: 1144265240
Provider Name (Legal Business Name): ROBERT ANDREW KOTAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CLARA BARTON BLVD
GARLAND TX
75042-5738
US

IV. Provider business mailing address

601 CLARA BARTON BLVD
GARLAND TX
75042-5738
US

V. Phone/Fax

Practice location:
  • Phone: 972-272-7887
  • Fax:
Mailing address:
  • Phone: 972-272-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL1914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: