Basic Information
| Provider Information | |||||||||
| NPI: | 1154471977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOTTSCHALL | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1507 S HIAWASSEE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328355718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072531000 | ||||||||
| FaxNumber: | 4072531010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1507 S HIAWASSEE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328355718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4072531000 | ||||||||
| FaxNumber: | 4072531010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | A92285 | CA | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207YP0228X | ME96710 | FL | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 00A922850 | 05 | CA | MEDICAID |