Provider Demographics
NPI:1922272749
Name:GOOTNICK, IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:GOOTNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:IRWIN
Other - Middle Name:
Other - Last Name:GOOTNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:329 GOODHILL RD
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-221-5204
Mailing Address - Fax:415-461-4416
Practice Address - Street 1:329 GOODHILL RD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-221-5204
Practice Address - Fax:415-461-4416
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG98622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry