| Bernard J. Gotway, Ph.d., P.c. | |
|
1701 Gateway Blvd Ste 447 Richardson TX 75080-3572 | |
| (972) 918-9333 | |
| (972) 783-8444 |
| Full Name | Bernard J. Gotway, Ph.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1701 Gateway Blvd, Richardson, Texas |
| Authorized Official Name and Position | Bernard J. Gotway (PRESIDENT / OWNER) |
| Authorized Official Contact | 9729189333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bernard J. Gotway, Ph.d., P.c. 1701 Gateway Blvd Ste 447 Richardson TX 75080-3572 Ph: (972) 918-9333 | Bernard J. Gotway, Ph.d., P.c. 1701 Gateway Blvd Ste 447 Richardson TX 75080-3572 Ph: (972) 918-9333 |
| NPI Number | 1447544812 |
|---|---|
| Provider Enumeration Date | 06/02/2011 |
| Last Update Date | 06/02/2011 |
| Medicare PECOS PAC ID | 5890965958 |
|---|---|
| Medicare Enrollment ID | O20170331000517 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447544812 | NPI | - | NPPES |
| 032366901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 22116 (Texas) | Primary |
| Provider Name | Bernard J Gotway |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1396721700 PECOS PAC ID: 6406980762 Enrollment ID: I20100823000485 |
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