Provider Demographics
NPI:1821671504
Name:KOTIN, LUKE JAMES
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:JAMES
Last Name:KOTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BAYLOR SCOTT & WHITE MEDICAL CENTER-ROUND ROCK
Mailing Address - Street 2:425 UNIVERSITY BLVD. SUITE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665
Mailing Address - Country:US
Mailing Address - Phone:512-509-0200
Mailing Address - Fax:
Practice Address - Street 1:BAYLOR SCOTT & WHITE MEDICAL CENTER-ROUND ROCK
Practice Address - Street 2:425 UNIVERSITY BLVD. SUITE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU8759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program