Provider Demographics
NPI:1568427052
Name:GOTA, CARMEN E (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:GOTA
Suffix:
Gender:
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1060 SOUTH MAIN STREET
Mailing Address - Street 2:BLDG A, STE 102B
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5260
Mailing Address - Country:US
Mailing Address - Phone:435-292-6492
Mailing Address - Fax:434-355-3950
Practice Address - Street 1:1060 SOUTH MAIN STREET
Practice Address - Street 2:BLDG A, STE 102B
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5260
Practice Address - Country:US
Practice Address - Phone:435-292-6492
Practice Address - Fax:434-355-3950
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN76241207RR0500X
OH35082592207RR0500X
UT12719806-1205207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2622013Medicaid
OHI07267Medicare UPIN
OHGO7351441Medicare PIN