Kotheimer, Thomas

Kotheimer, Thomas is an individual health care provider with primary practice located at 2161 Kingsley Ave Ste 200, Orange Park FL 32073-5113. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Kotheimer, Thomas can be contacted via phone (904) 727-3139.

Contact Information

Primary practice address
2161 Kingsley Ave Ste 200 Orange Park FL 32073-5113
Phone: (904) 727-3139
Fax: (904) 276-7434
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA 2559 Florida

Profile Details

NPI number 1235126053
LBN Legal business name Kotheimer, Thomas
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 6th, 2005
Last updated May 24th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235126053 NPPES
Florida MEDICAID 291828500
Florida Other Y03PU

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