Provider Demographics
NPI:1134193873
Name:GOTTFRIED, TAMAR K (MD)
Entity type:Individual
Prefix:
First Name:TAMAR
Middle Name:K
Last Name:GOTTFRIED
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 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 316
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-545-0059
Mailing Address - Fax:480-632-2134
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 316
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-545-0059
Practice Address - Fax:480-632-2134
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ26354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ65192Medicare ID - Type Unspecified