Provider Demographics
NPI:1265509103
Name:GOLDIS, GLENN E (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:GOLDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4570 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1143
Mailing Address - Country:US
Mailing Address - Phone:661-846-4540
Mailing Address - Fax:661-846-4525
Practice Address - Street 1:4580 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1104
Practice Address - Country:US
Practice Address - Phone:661-327-4411
Practice Address - Fax:661-847-4500
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG56436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine