Healthcare Provider Details

I. General information

NPI: 1972661296
Provider Name (Legal Business Name): JAROSLAW J KOTLARCZYK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 24TH ST
ANACORTES WA
98221-2562
US

IV. Provider business mailing address

PO BOX 189
COUPEVILLE WA
98239-0189
US

V. Phone/Fax

Practice location:
  • Phone: 360-293-3181
  • Fax:
Mailing address:
  • Phone: 360-678-4071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD2006-0737
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number45127
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC53430
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD33166
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: