Provider Demographics
NPI:1902984024
Name:GOTTESFELD, MARSHALL R (MD)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:R
Last Name:GOTTESFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 ELDORADO BLVD
Mailing Address - Street 2:SUITE 6250
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3408
Mailing Address - Country:US
Mailing Address - Phone:303-272-0751
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:1960 OGDEN ST STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3669
Practice Address - Country:US
Practice Address - Phone:303-318-3830
Practice Address - Fax:303-318-3825
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32176207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01021765Medicaid
G13772Medicare UPIN
CO01021765Medicaid
COCO303131Medicare PIN