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General NPI Number Information
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NPI Number | 1114110640
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Entity Type | Organization
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Legal Business Name | DAVID R. GOTHAM, JR., D.O., INCORPORATED
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Dates
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Enumeration Date | 08/17/2007
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 2204 PLAZA DR SUITE 210
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City | ROCKLIN
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State | CA
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Zip | 95765-4413
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Country | US
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Telephone | 916-771-9555
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Fax | 916-771-9556
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Provider Business Mailing Address
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Address Line | 7855 WINGATE CT
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City | GRANITE BAY
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State | CA
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Zip | 95746-9362
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Country | US
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Telephone | 916-791-9510
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID R GOTHAM JR.
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Credential | D.O.
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Telephone | 916-616-0510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20A8894
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License Number State | CA
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