Provider Demographics
NPI:1861634065
Name:SANDRA R. GOTMAN, D.P.M., P.A.
Entity Type:Organization
Organization Name:SANDRA R. GOTMAN, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-229-9596
Mailing Address - Street 1:11760 SW 40TH ST
Mailing Address - Street 2:SUITE 616
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-8100
Mailing Address - Country:US
Mailing Address - Phone:305-229-9595
Mailing Address - Fax:305-229-9596
Practice Address - Street 1:11760 SW 40TH ST
Practice Address - Street 2:SUITE 616
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8100
Practice Address - Country:US
Practice Address - Phone:305-229-9595
Practice Address - Fax:305-229-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1678213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
87910OtherBCBS
FL029757700Medicaid
87910OtherBCBS
FL4685500001Medicare NSC