Provider Demographics
NPI:1336133081
Name:GOTTLIEB, HAROLD ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:ELLIOT
Last Name:GOTTLIEB
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 1:5631 PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-6123
Mailing Address - Country:US
Mailing Address - Phone:281-599-5126
Mailing Address - Fax:281-398-2265
Practice Address - Street 1:701 S FRY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2255
Practice Address - Country:US
Practice Address - Phone:281-599-5126
Practice Address - Fax:281-398-2265
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7654207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87931Medicare UPIN
850563Medicare ID - Type Unspecified