Provider Demographics
NPI:1508022880
Name:GOLDBERG, AARON B (PA-C)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:B
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 1:541 W MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3666
Mailing Address - Country:US
Mailing Address - Phone:972-420-8500
Mailing Address - Fax:972-221-9752
Practice Address - Street 1:541 W MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3666
Practice Address - Country:US
Practice Address - Phone:972-420-8500
Practice Address - Fax:972-221-9752
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L24524Medicare PIN
TX8L24523Medicare PIN
TX8L24522Medicare PIN