Provider Demographics
NPI:1528023710
Name:GOLDBERG, RONALD B (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:GOLDBERG
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 1:1400 NW 10TH AVE
Mailing Address - Street 2:SUITE 805
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1000
Mailing Address - Country:US
Mailing Address - Phone:305-243-3636
Mailing Address - Fax:305-243-6575
Practice Address - Street 1:1450 NW 10TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1011
Practice Address - Country:US
Practice Address - Phone:305-243-3636
Practice Address - Fax:305-243-6575
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME37833207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL065057900Medicaid
FL95572Medicare UPIN
FL065057900Medicaid