Organization
WILLIAM F. COTHERN,D.O.,P.A.
Active
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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