Provider Demographics
NPI:1982860045
Name:JOHN COTTAM MD PA
Entity Type:Organization
Organization Name:JOHN COTTAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COTTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-962-4210
Mailing Address - Street 1:14310 N DALE MABRY HWY STE 180
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2059
Mailing Address - Country:US
Mailing Address - Phone:813-962-4210
Mailing Address - Fax:813-962-0566
Practice Address - Street 1:14310 N DALE MABRY HWY STE 180
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2059
Practice Address - Country:US
Practice Address - Phone:813-962-4210
Practice Address - Fax:813-962-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000831900Medicaid