Provider Demographics
NPI:1881831378
Name:TERRY J GOLDMAN D P M PA
Entity Type:Organization
Organization Name:TERRY J GOLDMAN D P M PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-4004
Mailing Address - Street 1:10630 PARIS ST
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4817
Mailing Address - Country:US
Mailing Address - Phone:305-558-4004
Mailing Address - Fax:954-437-2733
Practice Address - Street 1:10630 PARIS ST
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-4817
Practice Address - Country:US
Practice Address - Phone:305-558-4004
Practice Address - Fax:954-437-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1410213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041362300Medicaid
FL041362300Medicaid
FLBI198Medicare PIN