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NPI Code Detail

MEDICARE: WILLIAM JORDAN GOTTSCHALK DO

MEDICARE: WILLIAM JORDAN GOTTSCHALK DO
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
1207Q00000XFamily Medicine PhysicianOS15396FL

Other Identifiers

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

General Provider Information

NPI Number : 1306231873
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM JORDAN GOTTSCHALK DO
Provider Business Mailing Address
First Line : 1135 LAKE AVE
Second Line :
City : CLERMONT
State : FL
Zip : 34711-3037
Country : US
Telephone Number : 352-394-4035
Fax Number : 352-394-8585
Provider Business Practice Location Address
First Line : 1135 LAKE AVE
Second Line :
City : CLERMONT
State : FL
Zip : 34711-3037
Country : US
Telephone Number : 352-394-4035
Fax Number : 352-394-8585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2015
Last Update Date : 10/01/2020

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Directions to “ WILLIAM JORDAN GOTTSCHALK DO” Practice Location

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