Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 214 | AZ |
NPI | 1073627493 |
---|---|
Provider Name | Dr. Eugene Paul Goldman |
First Address | Montgomery, AL 36109-3725 |
Second Address | Montgomery, AL 36109-3725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T41654 | (02) | AZ |