Provider Demographics
NPI:1558873992
Name:GARY P GOTTLIEB MD PC
Entity Type:Organization
Organization Name:GARY P GOTTLIEB MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-547-4900
Mailing Address - Street 1:7140 E ROSEWOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1346
Mailing Address - Country:US
Mailing Address - Phone:520-547-4900
Mailing Address - Fax:520-547-2435
Practice Address - Street 1:7140 E ROSEWOOD ST STE B
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1346
Practice Address - Country:US
Practice Address - Phone:520-547-4900
Practice Address - Fax:520-547-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ850380Medicaid