Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME49059 | FL |
NPI | 1003902701 |
---|---|
Provider Name | Robert William Koss |
First Address | Valrico, FL 33596-8265 |
Second Address | Tampa, FL 33612-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 31/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02113 | BCBS (01) | FL |
045279300 | (05) | FL |
D50339 | (02) |