Provider Demographics
NPI:1457359457
Name:KOSER, HENRY JEROME (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JEROME
Last Name:KOSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
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:727-828-0823
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS2430207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0075216OtherGHI
FL062839500Medicaid
FL81675OtherBCBS
FLP00457437OtherRAILROAD MEDICARE
FL196371OtherWELLCARE
FLAA039ZMedicare PIN