Provider Demographics
NPI:1740345248
Name:WILLIAM F COTHERN, D.O., P.A.
Entity type:Organization
Organization Name:WILLIAM F COTHERN, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:COTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PA
Authorized Official - Phone:817-377-1243
Mailing Address - Street 1:4201 CAMP BOWIE BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-3928
Mailing Address - Country:US
Mailing Address - Phone:817-377-1243
Mailing Address - Fax:817-763-0631
Practice Address - Street 1:4201 CAMP BOWIE BLVD
Practice Address - Street 2:STE A
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-3928
Practice Address - Country:US
Practice Address - Phone:817-377-1243
Practice Address - Fax:817-763-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9330207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD75159Medicare UPIN
TX00J14UMedicare ID - Type Unspecified