Individual
ALAN RUSS GOTTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5341
(209) 342-2300
(209) 524-4240
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A34546
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A345460
BLUE SHIELD
CA
05
—
00A345460
—
CA
Enumeration date
11/04/2005
Last updated
08/11/2008
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