Provider Demographics
NPI:1780795781
Name:GOTFRYD, MARK A (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GOTFRYD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5505
Mailing Address - Country:US
Mailing Address - Phone:205-853-7878
Mailing Address - Fax:205-853-8272
Practice Address - Street 1:1703 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5505
Practice Address - Country:US
Practice Address - Phone:205-853-7878
Practice Address - Fax:205-853-8272
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00109213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL27-10029OtherUHC PROVIDER NUMBER
AL510-72959OtherBC/BS OF ALABAMA PROVIDER
AL510-71144OtherBC/BS OF ALABAMA
AL510-71144OtherBC/BS OF ALABAMA