Individual
GLENN E KOTZ
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1450 E VALLEY RD, SUITE 101, BASALT, CO 81621-8304
(970) 927-6101
(970) 927-6888
Mailing address
1450 E VALLEY RD, SUITE 101, BASALT, CO 81621-8304
(970) 927-6101
(970) 927-6888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
CO30756
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01037560
—
CO
Enumeration date
09/26/2005
Last updated
07/08/2007
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