Provider Demographics
NPI:1215206032
Name:GOLDMAN, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-7688
Mailing Address - Country:US
Mailing Address - Phone:503-516-7142
Mailing Address - Fax:
Practice Address - Street 1:581 OAK MEADOW DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-7688
Practice Address - Country:US
Practice Address - Phone:503-516-7142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD105312085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology