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General NPI Number Information
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NPI Number | 1780902932
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Entity Type | Organization
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Legal Business Name | JOEL GOTVALD, PA
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 12319 N MOPAC EXPY SUITE 250, PLAZA NORTH BLDG.
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City | AUSTIN
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State | TX
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Zip | 78758-2414
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Country | US
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Telephone | 512-339-9100
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Fax | 512-339-9105
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Provider Business Mailing Address
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Address Line | 12319 N MOPAC EXPY SUITE 250, PLAZA NORTH BLDG.
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City | AUSTIN
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State | TX
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Zip | 78758-2414
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Country | US
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Telephone | 512-339-9100
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Fax | 512-339-9105
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOEL G. GOTVALD
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Credential | M.D.
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Telephone | 512-339-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | K4694
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License Number State | TX
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