Provider Demographics
NPI:1447269444
Name:GOTTESMAN, GARY STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEPHEN
Last Name:GOTTESMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6051
Mailing Address - Fax:314-454-6225
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED ENDOCRINOLOGY AND DIABETES
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6051
Practice Address - Fax:314-454-6225
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR6P15207SG0201X, 207R00000X, 207RE0101X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207929712Medicaid
MO207929712Medicaid