Provider Demographics
NPI:1225123821
Name:GOLDMAN, DONALD G (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:757 PACIFIC ST
Mailing Address - Street 2:#B2
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2872
Mailing Address - Country:US
Mailing Address - Phone:831-373-4304
Mailing Address - Fax:831-373-0535
Practice Address - Street 1:757 PACIFIC ST
Practice Address - Street 2:#B2
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2872
Practice Address - Country:US
Practice Address - Phone:831-373-4304
Practice Address - Fax:831-373-0535
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG39633208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G396330Medicaid
CA00G396330Medicaid
CAA47890Medicare UPIN
CA00G396330Medicare ID - Type Unspecified