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General NPI Number Information
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NPI Number | 1306138706
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Entity Type | Organization
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Legal Business Name | KERRY N GOTT MD INC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 255 E BONITA AVE
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City | POMONA
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State | CA
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Zip | 91767-1923
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Country | US
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Telephone | 909-596-7733
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Fax | 909-450-0357
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Provider Business Mailing Address
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Address Line | 6023 HELLMAN AVE
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City | ALTA LOMA
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State | CA
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Zip | 91737-2827
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Country | US
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Telephone | 909-268-5645
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Fax | 909-450-0357
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Authorized Official
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Title or Position | OWNER
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Name | DR. KERRY NORMAN GOTT
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Credential | MD
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Telephone | 909-268-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G65566
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License Number State | CA
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