Healthcare Provider Details

I. General information

NPI: 1861470585
Provider Name (Legal Business Name): BETSY L KOTT-FLODSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY KOTT M.D.

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S LINCOLN ST
PORT ANGELES WA
98362-7848
US

IV. Provider business mailing address

901 S LINCOLN ST
PORT ANGELES WA
98362-7848
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-2022
  • Fax: 360-457-1686
Mailing address:
  • Phone: 360-452-2022
  • Fax: 360-457-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD00037625
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: