Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | L8701 | TX |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | L8701 | TX |
NPI | 1528034451 |
---|---|
Provider Name | Tyler D. Goldberg |
First Address | Austin, TX 78759-5295 |
Second Address | Austin, TX 78759-5295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
165245502 | (05) | TX |
H32579 | (02) | TX |
P00477944 | MEDICARE RAILROAD (01) | TX |