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Individual

C FRED GOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
191 W PROFESSIONAL PARK CT, BOWLING GREEN, KY 42104
(270) 782-7464
(270) 782-8025
Mailing address
PO BOX 1078, BOWLING GREEN, KY 42102-1078
(270) 782-7464
(270) 782-8025

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
20987
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000048588
BLUE CROSS BLUE SHIELD
KY
01
611077855
FED TAX ID
KY
05
64209877
KY
Enumeration date
07/13/2005
Last updated
06/13/2008
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