MEDICARE: GARY P GOTTLIEB MD PC

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	207RG0100X	Gastroenterology Physician

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	:	1558873992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY P GOTTLIEB MD PC

Provider Business Mailing Address
First Line	:	7140 E ROSEWOOD ST STE B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1346
Country	:	US
Telephone Number	:	520-547-4900
Fax Number	:	520-547-2435

Provider Business Practice Location Address
First Line	:	7140 E ROSEWOOD ST STE B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-1346
Country	:	US
Telephone Number	:	520-547-4900
Fax Number	:	520-547-2435

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY P GOTTLIEB
Credential	:	MD
Telephone Number	:	520-547-4900

Provider Enumeration Date	:	10/25/2017
Last Update Date	:	10/25/2017

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