Healthcare Provider Details

I. General information

NPI: 1780795781
Provider Name (Legal Business Name): MARK A GOTFRYD D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 CENTER POINT PKWY
BIRMINGHAM AL
35215-5505
US

IV. Provider business mailing address

1703 CENTER POINT PKWY
BIRMINGHAM AL
35215-5505
US

V. Phone/Fax

Practice location:
  • Phone: 205-853-7878
  • Fax: 205-853-8272
Mailing address:
  • Phone: 205-853-7878
  • Fax: 205-853-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00109
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: