Provider Demographics
NPI:1972661296
Name:KOTLARCZYK, JAROSLAW J (MD)
Entity Type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:J
Last Name:KOTLARCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0189
Mailing Address - Country:US
Mailing Address - Phone:360-678-4071
Mailing Address - Fax:
Practice Address - Street 1:1211 24TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2562
Practice Address - Country:US
Practice Address - Phone:360-293-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD33166207L00000X
NMMD2006-0737207L00000X
CO45127207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8212029Medicaid
WA0114KOOtherREGENCE BS
WAAB01385Medicare ID - Type Unspecified
WA0114KOOtherREGENCE BS