Individual
MALCOLM D GOTTLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1075 MASON AVE, DAYTONA BEACH, FL 32117
(386) 255-4596
(386) 258-3561
Mailing address
1075 MASON AVE, DAYTONA BEACH, FL 32117
(386) 255-4596
(386) 258-3561
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME57439
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007653200
—
FL
Enumeration date
01/10/2006
Last updated
04/23/2013
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