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NPI Code Detail

MEDICARE: GARRETT KENNETH GOTWAY MD, PHD

MEDICARE: GARRETT KENNETH GOTWAY MD, PHD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207SG0201XClinical Genetics (M.D.) PhysicianN5691TX
3208000000XPediatrics PhysicianN5691TX

General Provider Information

NPI Number : 1811108426
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARRETT KENNETH GOTWAY MD, PHD
Provider Business Mailing Address
First Line : P.O. BOX 845347
Second Line :
City : DALLAS
State : TX
Zip : 75284-5347
Country : US
Telephone Number : 214-456-2564
Fax Number : 214-456-2567
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number : 214-456-2564
Fax Number : 214-456-2567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2007
Last Update Date : 08/29/2014

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