Provider Demographics
NPI:1861455081
Name:GOLDBERG, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
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 1:10611 GARLAND RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2666
Mailing Address - Country:US
Mailing Address - Phone:214-660-0505
Mailing Address - Fax:214-660-4484
Practice Address - Street 1:10611 GARLAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2666
Practice Address - Country:US
Practice Address - Phone:214-660-0505
Practice Address - Fax:214-660-4484
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0469207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S4861OtherBCBS
TX045815002Medicaid
TX8D7170Medicare ID - Type Unspecified
TX045815002Medicaid