Provider Demographics
NPI:1750311569
Name:GOLDFARB, PHILIP ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALLEN
Last Name:GOLDFARB
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 1:1501 N GILBERT ROAD
Mailing Address - Street 2:CHW URGENT CARE
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-728-4100
Mailing Address - Fax:
Practice Address - Street 1:1501 N GILBERT ROAD
Practice Address - Street 2:CHW URGENT CARE
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-728-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
63950Medicare ID - Type Unspecified
AZZ120952Medicare PIN
D36921Medicare UPIN
AZZ132340Medicare UPIN
AZZ126048Medicare PIN
AZZ132361Medicare UPIN