Provider Demographics
NPI:1043261548
Name:GOTTENGER, EMANUEL E (MD)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:E
Last Name:GOTTENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 W. ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-496-4444
Mailing Address - Fax:561-496-2001
Practice Address - Street 1:5350 W. ATLANTICE AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-496-4444
Practice Address - Fax:561-496-2001
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81204208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI37336Medicare UPIN
FLU5009ZMedicare ID - Type Unspecified