Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 29486 | AL |
N | 2080P0207X | Pediatric Hematology-Oncologist | 28926 | IA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 29486 | AL |
NPI | 1124013826 |
---|---|
Provider Name | Frederick D Goldman |
First Address | Birmingham, AL 35294-0001 |
Second Address | Birmingham, AL 35233-1711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 26/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0090753 | (05) | IA |
10024 | WELLMARK BCBS (01) | IA |
109764 | (05) | AL |
F00302 | (02) |