Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G85091 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G85091 | CA |
NPI | 1104879014 |
---|---|
Provider Name | Dr. David H. Goltz |
First Address | Larkspur, CA 94939-1123 |
Second Address | Larkspur, CA 94939-1123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 22/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H48194 | (02) | CA |