Provider Demographics
NPI:1588641302
Name:GOLDMAN, REBECCA L (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:L
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 E RAY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6096
Mailing Address - Country:US
Mailing Address - Phone:480-494-2100
Mailing Address - Fax:480-494-2101
Practice Address - Street 1:4530 E RAY RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6094
Practice Address - Country:US
Practice Address - Phone:480-785-4775
Practice Address - Fax:480-785-0908
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ437469Medicaid
AZZ68443Medicare PIN
AZG69857Medicare UPIN
AZZ129616Medicare PIN