Provider Demographics
NPI:1891028023
Name:ALBERTO GOLDGABER M D LLC
Entity Type:Organization
Organization Name:ALBERTO GOLDGABER M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDGABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-427-2425
Mailing Address - Street 1:11520 SAINT CHARLES ROCK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2732
Mailing Address - Country:US
Mailing Address - Phone:314-209-9331
Mailing Address - Fax:314-447-0155
Practice Address - Street 1:11520 SAINT CHARLES ROCK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2732
Practice Address - Country:US
Practice Address - Phone:314-209-9331
Practice Address - Fax:314-447-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty