Provider Demographics
NPI:1861478257
Name:GOTKIN, PAUL NORMAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NORMAN
Last Name:GOTKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2291 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4516
Mailing Address - Country:US
Mailing Address - Phone:772-286-9912
Mailing Address - Fax:772-286-2405
Practice Address - Street 1:2291 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4516
Practice Address - Country:US
Practice Address - Phone:772-286-9912
Practice Address - Fax:772-286-2405
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U16651Medicare UPIN
87800Medicare ID - Type Unspecified