Individual
JOHN P KOOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
152 DRESDEN AVE, GARDINER, ME 04345-2615
(207) 582-6608
(207) 582-2258
Mailing address
152 DRESDEN AVE, GARDINER, ME 04345-2615
(207) 582-6608
(207) 582-2258
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
012564
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
286330099
—
ME
Enumeration date
07/28/2005
Last updated
10/16/2012
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