Healthcare Provider Details

I. General information

NPI: 1730462235
Provider Name (Legal Business Name): TAMAR K GOTTFRIED MD, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
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 Code261Q00000X
TaxonomyClinic/Center
License Number26354
License Number StateAZ

VIII. Authorized Official

Name: VERONICA CANTUA
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-545-0059