Provider Demographics
NPI:1154471977
Name:GOTTSCHALL, JOSHUA A (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:GOTTSCHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5718
Mailing Address - Country:US
Mailing Address - Phone:407-253-1000
Mailing Address - Fax:407-253-1010
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-253-1000
Practice Address - Fax:407-253-1010
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92285207Y00000X
FLME96710207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A922850Medicaid
00A922850Medicare ID - Type Unspecified
CA00A922850Medicaid