Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 259369 | NY |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD208145 | LA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD441388 | PA |
NPI | 1184745952 |
---|---|
Provider Name | Andrew William Gottschalk |
First Address | New Orleans, LA 70121-2429 |
Second Address | Jefferson, LA 70121-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00709541 | (05) | MS |
03296595 | (05) | NY |
102534788 | (05) | PA |
2402706 | (05) | LA |
778143000 | (05) | MN |