Individual
MR. JON P BOETTGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
12902 USF MAGNOLIA DR, TAMPA, FL 33612-9416
(813) 745-4673
Mailing address
PO BOX 198441, ATLANTA, GA 30384-8441
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA12179
TX
363A00000X
Physician Assistant
Primary
PA9105512
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
391145503
—
TX
Enumeration date
07/08/2010
Last updated
05/06/2022
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