Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME34601 | FL |
NPI | 1154317121 |
---|---|
Provider Name | Dr. Richard Ian Goldberger |
First Address | Tampa, FL 33603-1433 |
Second Address | Tampa, FL 33603-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04029 | BCBS (01) | FL |
0624143 | AETNA (01) | FL |
D50904 | (02) | FL |