Individual
RYAN CLARKE GOTTFREDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236
(210) 292-6225
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-6225
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0102203077
VA
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
0102203077
VA
Other
Enumeration date
07/05/2010
Last updated
07/27/2018
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