Provider Demographics
NPI:1609823210
Name:GOLGERT, REBECCA D (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:D
Last Name:GOLGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2420 CASTILLO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4346
Mailing Address - Country:US
Mailing Address - Phone:805-563-1999
Mailing Address - Fax:805-563-4999
Practice Address - Street 1:2420 CASTILLO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4346
Practice Address - Country:US
Practice Address - Phone:805-563-1999
Practice Address - Fax:805-563-4999
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45308207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34848100Medicaid