Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | G65566 | CA |
NPI | 1013955186 |
---|---|
Provider Name | Dr. Kerry Norman Gott |
First Address | Alta Loma, CA 91701-8389 |
Second Address | Pomona, CA 91767-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C655660 | (05) | CA |
BG1839654 | DEA CERT # (01) | CA |
BK903Z | MEDICARE NO CAL PTAN (01) | |
E54189 | (02) | CA |
G65566 | CA LICENSE # (01) | CA |
GR0059670 | (05) | CA |