Individual
JOURDAN R GOTTLIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 17TH AVE, SEATTLE, WA 98122-5711
(206) 320-2580
(206) 320-4073
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD00023270
WA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD00023270
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992883847
—
WA
Enumeration date
11/01/2006
Last updated
01/06/2020
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