| Doctor Name: | DR. MARVIN J GOTTSCHALL |
| NPI Number: | 1982662169 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD00004559 |
| Business Practice Address: | 701 Hospital Loop 92 Mdg Ste 132 Fairchild Afb, WA - 99011 |
| Business Phone Number: | 5092472617 |
| Business Fax Number: | |
| Mailing Address: | 5505 S Custer Rd, SPOKANE |
| State: | WA |
| Postal Code: | 992231628 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/04/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | MD00004559 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |