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Individual

THOMAS KOTHEIMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
2161 KINGSLEY AVE, STE 200, ORANGE PARK, FL 32073-5113
(904) 727-3139
(904) 276-7434
Mailing address
9143 PHILIPS HWY, STE 560, JACKSONVILLE, FL 32256-1348
(904) 363-2113
(904) 363-7453

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 2559
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
291828500
FL
01
Y03PU
BCBSFL
FL
Enumeration date
10/06/2005
Last updated
05/24/2012
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