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General NPI Number Information
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NPI Number | 1356423768
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Entity Type | Individual
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Provider Name | JOSEPH GUY KOTORA JR. D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD NAVAL HOSPITAL CAMP LEJEUNE
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2538
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Country | US
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Telephone | 910-450-4840
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Fax |
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Provider Business Mailing Address
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Address Line | 824 COMMONS DR N
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8146
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Country | US
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Telephone | 732-266-6077
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 2014-01514
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 2014-01514
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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