Individual
DR. IVAN RONALD KOOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
337 COLLINS TER, DELHI, NY 13753-1402
(607) 746-8122
Mailing address
337 COLLINS TER, DELHI, NY 13753-1402
(607) 746-8122
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
097360
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
097360
MEDICAL LICENSE NUMBER
NY
Enumeration date
03/19/2012
Last updated
03/19/2012
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