MEDICARE: MR. DAVID GOZAL M.D.

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	208000000X	Pediatrics Physician	01058585A	IN
2	2080P0214X	Pediatric Pulmonology Physician	2018039696	MO
3	2080S0012X	Pediatric Sleep Medicine Physician	2018039696	MO
4	2080P0214X	Pediatric Pulmonology Physician	32960	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164406153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID GOZAL M.D.

Provider Business Mailing Address
First Line	:	1448 10TH AVE STE 304
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3579
Country	:	US
Telephone Number	:	304-733-8728
Fax Number	:	304-691-8591

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DR STE 3500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3655
Country	:	US
Telephone Number	:	304-691-1300
Fax Number	:	304-691-1375

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	01/04/2024

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Directions to “ MR. DAVID GOZAL M.D.” Practice Location

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