Provider Demographics
NPI:1023020427
Name:JEROME KOSER DO PA
Entity Type:Organization
Organization Name:JEROME KOSER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-8600
Mailing Address - Street 1:PO BOX 20126
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0126
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:2349 SUNSET POINT RD
Practice Address - Street 2:UNIT 403
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1439
Practice Address - Country:US
Practice Address - Phone:727-796-8600
Practice Address - Fax:727-796-8660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS2430207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG8306OtherRAILROAD MEDICARE
FLAA040Medicare PIN