Healthcare Provider Details

I. General information

NPI: 1598724619
Provider Name (Legal Business Name): DR. DOUGLAS GOTTSCHALK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 12/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16230 SUMMERLIN RD SUITE 215
FORT MYERS FL
33908-5768
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6050
  • Fax:
Mailing address:
  • Phone: 239-424-1400
  • Fax: 239-424-1421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberE-4158
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberOS11438
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberM8003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: