Provider Demographics
NPI:1639177645
Name:GOTT, C FRED (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:FRED
Last Name:GOTT
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:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1078
Mailing Address - Country:US
Mailing Address - Phone:270-782-7464
Mailing Address - Fax:270-782-8025
Practice Address - Street 1:191 W PROFESSIONAL PARK CT
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-782-7464
Practice Address - Fax:270-782-8025
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20987207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000048588OtherBLUE CROSS BLUE SHIELD
KY611077855OtherFED TAX ID
KY64209877Medicaid
KYC25409Medicare UPIN
KY000000048588OtherBLUE CROSS BLUE SHIELD