Provider Demographics
NPI:1568427052
Name:GOTA, CARMEN E (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:GOTA
Suffix:
Gender:F
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:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-879-7610
Mailing Address - Fax:435-879-7292
Practice Address - Street 1:1490 E FOREMASTER DR STE 220
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4498
Practice Address - Country:US
Practice Address - Phone:435-879-7610
Practice Address - Fax:435-879-7292
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082592207RR0500X
UT12719806-1205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622013Medicaid
OHI07267Medicare UPIN
OHGO7351441Medicare PIN