Ryan Clarke Gottfredson, D.O.

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

License

0102203077 Issued in VA

Practice address

1100 Wilford Hall Loop BLDG 4554
Jbsa Lackland, TX 78236

Phone

(210) 292-6225

NPI assigned

Jul 5, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Utah Valley Pediatrics L.L.C.

  • Pediatrics Physician
  • Provo, UT
  • NPI 1497812721
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532649600000",
    "number": "1447562616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-292-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "78236",
            "telephone_number": "210-292-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTFREDSON",
        "first_name": "RYAN",
        "middle_name": "CLARKE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-05",
        "last_updated": "2018-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0102203077",
            "primary": false
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "VA",
            "license": "0102203077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Elva Gonzales, NP-C
• Xenia Brianna Gonzalez, MD
• Marylene Goode, PSY.D.
• Aaron James Goodrich, M.D.
• Harrison Gordner, DMD
• Amanda Nicole Goyet, PA-C
• Stephen Scott Grabner II
• Palmira R Granado, LCSW
• Jay Douglas Graver, DMD
• Abigail Greenwell, MD

• Public Health & General Preventive Medicine Physician in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Public Health & General Preventive Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.