MEDICARE: GARY GOTTHELF, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME35416	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17449	OTHER	FL	BCBS OF FLORIDA

General Provider Information

NPI Number	:	1023000817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY GOTTHELF, M.D., P.A.

Provider Business Mailing Address
First Line	:	4511 N DAVIS HWY
Second Line	:	1-C
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2720
Country	:	US
Telephone Number	:	850-477-3252
Fax Number	:	850-477-2659

Provider Business Practice Location Address
First Line	:	4511 N DAVIS HWY
Second Line	:	1-C
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2720
Country	:	US
Telephone Number	:	850-477-3252
Fax Number	:	850-477-2659

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY GOTTHELF
Credential	:	M.D.
Telephone Number	:	850-477-3252

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	01/31/2014

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