Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT204391 | PA |
N | 208000000X | Pediatrician | TRN24124 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME135289 | FL |
NPI | 1225474158 |
---|---|
Provider Name | Dr. John Joseph Kotula III |
First Address | St Petersburg, FL 33701-4634 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2013 |
Last Update Date | 13/08/2021 |