Provider Demographics
NPI:1023057296
Name:GOTHELF, DAVID S (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GOTHELF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:100 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6391
Practice Address - Country:US
Practice Address - Phone:702-269-9995
Practice Address - Fax:702-944-4056
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVD0479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV479OtherSTATE LICENSE
NV1023057296Medicaid
NV002019093Medicaid