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General NPI Number Information
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NPI Number | 1659352508
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Entity Type | Individual
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Provider Name | GARY DAVID GOTTLIEB PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 02/07/2026
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Provider Practice Location Address
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Address Line | 451 S COUNTRY CLUB DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1239
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Country | US
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Telephone | 561-762-6354
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Fax | 561-966-0531
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Provider Business Mailing Address
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Address Line | 451 S COUNTRY CLUB DR
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City | ATLANTIS
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State | FL
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Zip | 33462-1239
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Country | US
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Telephone | 561-762-6354
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Fax | 561-966-0531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA2199
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License Number State | FL
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