Basic Information
| Provider Information | |||||||||
| NPI: | 1306138706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KERRY N GOTT MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6023 HELLMAN AVE | ||||||||
| Address2: | |||||||||
| City: | ALTA LOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917372827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9092685645 | ||||||||
| FaxNumber: | 9094500357 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E BONITA AVE | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917671923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095967733 | ||||||||
| FaxNumber: | 9094500357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | GOTT | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
| AuthorizedOfficialMiddleName: | NORMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9092685645 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | G65566 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.