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NPI Code Detail

MEDICARE: MR. JEREMY D KOTIN

MEDICARE: MR. JEREMY D KOTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1861140865
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEREMY D KOTIN
Provider Business Mailing Address
First Line : 2106 QUAIL RUN
Second Line :
City : SAN MARCOS
State : TX
Zip : 78666-9495
Country : US
Telephone Number : 512-757-1257
Fax Number :
Provider Business Practice Location Address
First Line : 925 CITY CENTRAL AVE
Second Line :
City : CONROE
State : TX
Zip : 77304-2981
Country : US
Telephone Number : 936-202-5291
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2022
Last Update Date : 03/17/2022

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