Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G76127 | CA |
N | 2080P0207X | Pediatric Hematology-Oncologist | G76127 | CA |
NPI | 1083710891 |
---|---|
Provider Name | Dr. Robert E. Goldsby |
First Address | San Francisco, CA 94143-0001 |
Second Address | San Francisco, CA 94143-2204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G761270 | (05) | CA |
G47113 | (02) | CA |