Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 19681 | WA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | G44889 | CA |
NPI | 1104989649 |
---|---|
Provider Name | Robert David Goldman |
First Address | Mission Hills, CA 91346-9602 |
Second Address | Valencia, CA 91355-4466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 17/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G448890 | (05) | CA |
1256106 | (05) | WA |
AO4565 | (02) | CA |
AO4565 | (02) | WA |