Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | DO3856 | FL |
NPI | 1629440870 |
---|---|
Provider Name | Wayne Goldman |
First Address | Davie, FL 33325-3306 |
Second Address | Davie, FL 33325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |