Organization
WILLIAM F. COTHERN,D.O.,P.A.
Active
Other names
Dermatology and Laser Center of Ft. Worth
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM FORREST COTHERN D.O.,P.A. (OWNER/DOCTOR)
(817) 377-1243
Entity
Organization
Contact information
Practice address
4201 CAMP BOWIE BLVD, STE. A, FT WORTH, TX 76107-3928
(817) 377-1243
(817) 763-0631
Mailing address
4201 CAMP BOWIE BLVD, STE. A, FT WORTH, TX 76107-3928
(817) 377-1243
(817) 763-0631
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
F9330
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J14U
MEDICARE PTAN
TX
05
—
123065802
—
TX
Enumeration date
03/21/2011
Last updated
03/21/2011
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