Healthcare Provider Details

I. General information

NPI: 1134193873
Provider Name (Legal Business Name): TAMAR K GOTTFRIED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S DOBSON RD SUITE 316
MESA AZ
85202-4725
US

IV. Provider business mailing address

1520 S DOBSON RD SUITE 316
MESA AZ
85202-4725
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-0059
  • Fax: 480-632-2134
Mailing address:
  • Phone: 480-545-0059
  • Fax: 480-632-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26354
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: