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General NPI Number Information
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NPI Number | 1780795781
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Entity Type | Individual
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Provider Name | MARK A GOTFRYD D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1703 CENTER POINT PKWY
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City | BIRMINGHAM
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State | AL
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Zip | 35215-5505
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Country | US
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Telephone | 205-853-7878
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Fax | 205-853-8272
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Provider Business Mailing Address
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Address Line | 1703 CENTER POINT PKWY
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City | BIRMINGHAM
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State | AL
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Zip | 35215-5505
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Country | US
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Telephone | 205-853-7878
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Fax | 205-853-8272
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00109
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License Number State | AL
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