Provider Demographics
NPI:1629041470
Name:GOLDBERG, STANLEY JULIAN (MD)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:JULIAN
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2701 E ELVIRA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-7124
Mailing Address - Country:US
Mailing Address - Phone:520-626-6508
Mailing Address - Fax:520-626-6571
Practice Address - Street 1:535 N WILMOT RD
Practice Address - Street 2:SUITE #101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711
Practice Address - Country:US
Practice Address - Phone:520-694-9988
Practice Address - Fax:520-694-9917
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ59432080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD43973Medicare UPIN