MEDICARE: ROBERT ALLISON GOTSHALL MD

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	00011727	WA

General Provider Information

NPI Number	:	1366604597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ALLISON GOTSHALL MD

Provider Business Mailing Address
First Line	:	15540 BEACH DR NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6736
Country	:	US
Telephone Number	:	206-364-4752
Fax Number	:

Provider Business Practice Location Address
First Line	:	15540 BEACH DR NE
Second Line	:
City	:	LAKE FOREST PARK
State	:	WA
Zip	:	98155-6736
Country	:	US
Telephone Number	:	206-364-4752
Fax Number	:

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

Provider Enumeration Date	:	06/29/2008
Last Update Date	:	06/29/2008

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