Provider Demographics
NPI:1316915010
Name:GOTTESMAN, ANDREW R (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:GOTTESMAN
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 1:7515 GREENVILLE AVE
Mailing Address - Street 2:# 706
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231
Mailing Address - Country:US
Mailing Address - Phone:214-360-9877
Mailing Address - Fax:214-360-9256
Practice Address - Street 1:7515 GREENVILLE AVE
Practice Address - Street 2:# 706
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-360-9877
Practice Address - Fax:214-360-9256
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2583207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000U72NMedicaid
TXP000U72NMedicaid
TX00U72NMedicare PIN