Individual
DR. LAWRENCE J. GOTTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1621 S NASHVILLE ST, SUITE 104, RUSSELLVILLE, KY 42276-8871
(270) 726-4444
(270) 726-4400
Mailing address
1621 S NASHVILLE ST, SUITE 104, RUSSELLVILLE, KY 42276-8871
(270) 726-4444
(270) 726-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02661
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000176043
BLUE CROSS BLUE SHIELD
KY
01
—
080160808
MEDICARE RAILROAD
KY
01
—
1837202
MEDICARE GROUP NUMBER
KY
05
—
64010895
—
KY
Enumeration date
11/22/2006
Last updated
05/19/2011
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