Provider Demographics
NPI:1730117102
Name:GOLDFARB, LEONARD RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:RAY
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11515 CRAIG CT
Mailing Address - Street 2:APT. 431
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5293
Mailing Address - Country:US
Mailing Address - Phone:314-989-9144
Mailing Address - Fax:314-289-6533
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004030335207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine