Provider Demographics
NPI:1013913359
Name:GOTTEHRER, ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:GOTTEHRER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:918-488-6010
Practice Address - Street 1:10505 E 91ST ST
Practice Address - Street 2:SUITE 208
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5801
Practice Address - Country:US
Practice Address - Phone:918-307-5470
Practice Address - Fax:918-307-5471
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK17603207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100013710AMedicaid
OK100013710AMedicaid