Provider Demographics
NPI:1780681635
Name:GOLDMAN, LAWRENCE NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NORMAN
Last Name:GOLDMAN
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 1:8953 GOLDEN MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-3310
Mailing Address - Country:US
Mailing Address - Phone:340-998-6648
Mailing Address - Fax:
Practice Address - Street 1:2789 S STATE ROAD 7 STE 100-200
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-898-5100
Practice Address - Fax:561-898-5101
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIVI1128174400000X
SC87454207RG0100X
FLME134520207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI0020215Medicare PIN
A45709Medicare UPIN