Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 43508 | MN |
NPI | 1013995034 |
---|---|
Provider Name | Gary S Goldberg |
First Address | Mankato, MN 56002-8674 |
Second Address | Mankato, MN 56001-6076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 10/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0568394 | MEDICAID (01) | IA |
140754 | UCARE (01) | MN |
1808800 | AMERICAS PPO (01) | MN |
1900310 | MEDICA (01) | MN |
340019399 | RR MEDICARE (01) | |
392183200 | (05) | MN |
47D36GO | BCBS (01) | MN |
H43428 | (02) | |
HP34028 | HEALTH PARTNERS (01) | MN |
NA2951028013 | PREFFERED ONE (01) | MN |