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General NPI Number Information
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NPI Number | 1659825867
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Entity Type | Organization
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Legal Business Name | ICTM
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 93 SW PALM COVE DR
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City | PALM CITY
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State | FL
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Zip | 34990-4318
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Country | US
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Telephone | 301-466-9858
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Fax |
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Provider Business Mailing Address
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Address Line | 93 SW PALM COVE DR
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City | PALM CITY
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State | FL
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Zip | 34990-4318
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Country | US
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Telephone | 301-466-9858
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RONALD ERIC GOTS
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Credential | M.D., PH.D.
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Telephone | 301-466-9858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number | D0015004
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License Number State | MD
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