Healthcare Provider Details

I. General information

NPI: 1902972607
Provider Name (Legal Business Name): DR MARK A GOTFRYD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 02/01/2008
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 TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00109
License Number StateAL

VIII. Authorized Official

Name: DR. MARK GOTFRYD
Title or Position: PRESIDENT
Credential: DPM
Phone: 205-853-7878