=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548284243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERRY A GOTSIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 08/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 2ND AVE N SUITE 202
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-8800
-----------------------------------------------------
Fax | 239-263-8300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 2ND AVE N SUITE 202
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34102-5753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-263-8800
-----------------------------------------------------
Fax | 239-263-8300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME38175
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------