Provider Demographics
NPI:1053406207
Name:KOS, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:KOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 NE 47TH ST
Mailing Address - Street 2:#100
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7729
Mailing Address - Country:US
Mailing Address - Phone:954-771-3303
Mailing Address - Fax:954-771-3612
Practice Address - Street 1:1930 NE 47TH ST
Practice Address - Street 2:#100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7718
Practice Address - Country:US
Practice Address - Phone:954-771-3303
Practice Address - Fax:954-771-3612
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09370OtherBC
110234599OtherRR MEDICARE
110234599OtherRR MEDICARE
09370Medicare ID - Type Unspecified