Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2045 | CA |
Y | 222Z00000X | Podiatrist | E2045 | CA |
NPI | 1003993940 |
---|---|
Provider Name | Flair D. Goldman |
First Address | Oakland, CA 94612-3429 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 08/07/2007 |