Individual
DR. RODERIC DEAN GOTTULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 KENYON RD STE Q, FORT DODGE, IA 50501-5776
(515) 574-8519
(515) 574-8514
Mailing address
800 KENYON RD STE Q, FORT DODGE, IA 50501-5776
(515) 574-8519
(515) 574-8514
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29988
CO
207Q00000X
Family Medicine Physician
Primary
44546
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29988
STATE LICENSE
CO
Enumeration date
03/20/2007
Last updated
07/21/2022
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