Organization
KOTLARZ ENT AND FACIAL PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK P KOTLARZ MD (PHYSICIAN)
(850) 471-2377
Entity
Organization
Contact information
Practice address
6100 N DAVIS HWY, PENSACOLA, FL 32504-6950
(850) 471-2377
(850) 471-9975
Mailing address
6100 N DAVIS HWY, PENSACOLA, FL 32504-6950
(850) 471-2377
(850) 471-9975
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K3071
MEDICARE GROUP
FL
Enumeration date
07/31/2007
Last updated
05/18/2021
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