Provider Demographics
NPI:1740385442
Name:GOTTHOFFER, RICHARD GOTTHOFFER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GOTTHOFFER
Last Name:GOTTHOFFER
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 1:19045 SHILOH RANCH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-1248
Mailing Address - Country:US
Mailing Address - Phone:719-494-1164
Mailing Address - Fax:
Practice Address - Street 1:19045 SHILOH RANCH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-1248
Practice Address - Country:US
Practice Address - Phone:719-494-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO447152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology