Provider Demographics
NPI:1720045834
Name:GOLDBERG, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
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 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-587-4672
Mailing Address - Fax:502-587-4088
Practice Address - Street 1:3991 DUTCHMANS LN STE 405
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-6686
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37030207V00000X, 2086X0206X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000020583VOtherHUMANA PROVIDER NUMB
KY1988251OtherCIGNA PROVIDER NUMBER
KY64045040Medicaid
KY7872269OtherAETNA PROVIDER NUMB
IN200321900AMedicaid
KY980000377OtherRAILRAOD MEDICARE
KY000000216256OtherANTHEM PROVIDER NUMB
KY0299014Medicare PIN
IN200321900AMedicaid
KY000000216256OtherANTHEM PROVIDER NUMB
KY7872269OtherAETNA PROVIDER NUMB
KY000020583VOtherHUMANA PROVIDER NUMB