Provider Demographics
NPI:1629044946
Name:GOLDBERG, HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:M
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:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3826
Practice Address - Country:US
Practice Address - Phone:636-332-8228
Practice Address - Fax:636-332-1190
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105258174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
387857OtherHEALTHLINK
MO208724708Medicaid
169683OtherGROUP HEALTH PLAN
MO118991OtherBLUE CROSS BLUE SHIELD
4800247OtherUNITED HEALTH CARE
889462OtherCOMMUNITY CARE PLUS
MOP0081597Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO118991OtherBLUE CROSS BLUE SHIELD
MO909414112Medicare ID - Type UnspecifiedMEDICARE MISSOURI