Provider Demographics
NPI:1437737798
Name:GOTTWALT, BRIAN ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANDREW
Last Name:GOTTWALT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1920 W 1ST ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4220
Mailing Address - Country:US
Mailing Address - Phone:336-716-4479
Mailing Address - Fax:336-716-1317
Practice Address - Street 1:2630 WILLARD DAIRY RD STE 203
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8328
Practice Address - Country:US
Practice Address - Phone:336-884-3770
Practice Address - Fax:336-884-3771
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2024-01947207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine