Provider Demographics
NPI:1952301541
Name:GOTCHER, JANE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANNE
Last Name:GOTCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NEAL ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-0917
Mailing Address - Country:US
Mailing Address - Phone:931-528-7797
Mailing Address - Fax:931-372-0098
Practice Address - Street 1:1101 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0917
Practice Address - Country:US
Practice Address - Phone:931-528-7797
Practice Address - Fax:931-372-0098
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3080665Medicaid
TN3151715OtherBLUECROSS PROVIDER NUMBER
TN3080665Medicaid
TNF73383Medicare UPIN