Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 3065 | AZ |
N | 208200000X | Surgeon | 3065 | AZ |
N | 208600000X | Surgeon | 3065 | AZ |
NPI | 1861571960 |
---|---|
Provider Name | Thomas G Kotoske |
First Address | Phoenix, AZ 85027 |
Second Address | Phoenix, AZ 85027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
329145 | (05) | AZ |
F89749 | (02) |