Provider Demographics
NPI:1851570774
Name:ANDREW GOTTESMAN, M.D., P.A.
Entity Type:Organization
Organization Name:ANDREW GOTTESMAN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOTTESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-360-9877
Mailing Address - Street 1:7515 GREENVILLE AVE
Mailing Address - Street 2:SUITE 706
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3831
Mailing Address - Country:US
Mailing Address - Phone:214-360-9877
Mailing Address - Fax:214-360-9256
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:SUITE 706
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3831
Practice Address - Country:US
Practice Address - Phone:214-360-9877
Practice Address - Fax:214-360-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2583207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000U72NMedicaid
TXP000U72NMedicaid
TXC78468Medicare UPIN