=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437962917
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL GOTHARD ARNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2025
-----------------------------------------------------
Last Update Date | 02/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1670 JOHN F KENNEDY RD
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52002-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-582-1220
-----------------------------------------------------
Fax | 563-582-8089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1670 JOHN F KENNEDY RD
-----------------------------------------------------
City | DUBUQUE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52002-5106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-582-1220
-----------------------------------------------------
Fax | 563-582-8089
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | A183037
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------