Healthcare Provider Details

I. General information

NPI: 1356476808
Provider Name (Legal Business Name): CLINTON THOMAS GOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HUMMINGBIRD CIR
HENDERSON NV
89014-2153
US

IV. Provider business mailing address

14 HUMMINGBIRD CIR
HENDERSON NV
89014-2153
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-3322
  • Fax: 702-891-0970
Mailing address:
  • Phone: 702-450-3322
  • Fax: 702-891-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4436
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberG033535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: