Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | L2286 | TX |
N | 208000000X | Pediatrician | L2286 | TX |
Y | 2080P0207X | Pediatric Hematology-Oncologist | L2286 | TX |
NPI | 1134209489 |
---|---|
Provider Name | Stephen Gottschalk |
First Address | Memphis, TN 38105-3678 |
Second Address | Memphis, TN 38105-3678 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 01/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
146759901 | (05) | TX |
H44297 | (02) | |
Q031338 | (05) | TN |