MEDICARE: WILLIAM FORREST COTHERN DO

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
1	207N00000X	Dermatology Physician	F9330	TX

General Provider Information

NPI Number	:	1962493445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM FORREST COTHERN DO

Provider Business Mailing Address
First Line	:	4201 CAMP BOWIE BLVD
Second Line	:	STE A
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3928
Country	:	US
Telephone Number	:	817-377-1243
Fax Number	:	817-763-0631

Provider Business Practice Location Address
First Line	:	4201 CAMP BOWIE BLVD
Second Line	:	STE A
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3928
Country	:	US
Telephone Number	:	817-377-1243
Fax Number	:	817-763-0631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	08/04/2017

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