Healthcare Provider Details

I. General information

NPI: 1013913359
Provider Name (Legal Business Name): ANDREW GOTTEHRER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 E 91ST ST SUITE 208
TULSA OK
74133-5801
US

IV. Provider business mailing address

6600 S YALE AVE SUITE 1400
TULSA OK
74136-3347
US

V. Phone/Fax

Practice location:
  • Phone: 918-307-5470
  • Fax: 918-307-5471
Mailing address:
  • Phone: 918-488-6001
  • Fax: 918-488-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number17603
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: