Basic Information
Provider Information
NPI: 1306898325
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOTTLIEB
FirstName: MARC
MiddleName: S
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1700 SPRINGHILL AVE
Address2: SUITE 100
City: MOBILE
State: AL
PostalCode: 366041407
CountryCode: US
TelephoneNumber: 2514351200
FaxNumber: 2514353567
Practice Location
Address1: 1700 SPRINGHILL AVE
Address2: SUITE 100
City: MOBILE
State: AL
PostalCode: 366041407
CountryCode: US
TelephoneNumber: 2514351200
FaxNumber: 2514356357
Other Information
ProviderEnumerationDate: 05/17/2006
LastUpdateDate: 03/26/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RP1001X9727ALY Allopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease

No ID Information.


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