Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G0416 | TX |
Y | 207ND0101X | MOHS-Micrographic Surgeon | G0416 | TX |
N | 207ND0900X | Dermatopathologist | G0416 | TX |
N | 207NS0135X | Procedural Dermatology | G0416 | TX |
NPI | 1023001708 |
---|---|
Provider Name | Dr. Leonard H. Goldberg |
First Address | Houston, TX 77030-4519 |
Second Address | Houston, TX 77030-4519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 28/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C16193 | (02) | TX |