Individual
GERALD W BOTTENFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
210 LAKE RD STE 600, LAKE JACKSON, TX 77566-4982
(979) 297-7337
(979) 297-9096
Mailing address
210 LAKE RD STE 600, LAKE JACKSON, TX 77566-4982
(979) 297-7337
(979) 266-9076
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
G4086
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121182303
—
TX
05
—
121182304
—
TX
01
—
82971Y
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/26/2006
Last updated
12/19/2019
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