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General NPI Number Information
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NPI Number | 1780350892
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Entity Type | Organization
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Legal Business Name | JOHN COTTAM MD PA
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Dates
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Enumeration Date | 08/18/2021
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 222 W MAIN ST
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City | BARTOW
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State | FL
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Zip | 33830-4511
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Country | US
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Telephone | 813-962-4210
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Fax | 813-962-0566
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Provider Business Mailing Address
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Address Line | 14310 N DALE MABRY HWY STE 180
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City | TAMPA
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State | FL
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Zip | 33618-2059
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Country | US
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Telephone | 813-962-4210
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Fax | 813-962-0566
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | SHAWNA FRAME
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Credential |
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Telephone | 423-525-5993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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