Provider Demographics
NPI:1255490264
Name:GOLDBERG, SCOTT FRANKLIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:FRANKLIN
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:MS:X6-ORT
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-7530
Practice Address - Fax:206-341-0195
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17801363AS0400X
WAPA60801172363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFT721AOtherSA MEDICAL PHYSICIANS OF CA PTAN
CAMEDICAL LICENSEOtherPA 17801
CAMEDICAL LICENSEOtherPA 17801