Provider Demographics
NPI:1013955186
Name:GOTT, KERRY NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:NORMAN
Last Name:GOTT
Suffix:
Gender:M
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:PO BOX 9389
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-8389
Mailing Address - Country:US
Mailing Address - Phone:909-268-5645
Mailing Address - Fax:909-450-0357
Practice Address - Street 1:255 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-596-7733
Practice Address - Fax:909-450-0357
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65566207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
BK903ZOtherMEDICARE NO CAL PTAN
CAG65566OtherCA LICENSE #
CA00C655660Medicaid
CAGR0059670Medicaid
CAGR0059670Medicaid
CA00C655660Medicaid
CAGR0059670Medicaid