Provider Demographics
NPI:1982635595
Name:GOLDBERG, RICHARD ALAN (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2163 SOUTH U.S. HIGHWAY 1
Mailing Address - Street 2:DRIFTWOOD FAMILY PRACTICE , P.A.
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-7338
Mailing Address - Country:US
Mailing Address - Phone:561-746-0208
Mailing Address - Fax:561-575-1267
Practice Address - Street 1:2163 SOUTH U.S. HWY 1
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7338
Practice Address - Country:US
Practice Address - Phone:561-746-0208
Practice Address - Fax:561-575-1267
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 6807207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine