Provider Demographics
NPI:1669694857
Name:HALEVIE-GOLDMAN, BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:HALEVIE-GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 CITRUS CIR 115
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2694
Mailing Address - Country:US
Mailing Address - Phone:925-478-8678
Mailing Address - Fax:925-478-8677
Practice Address - Street 1:350 CHADBOURNE RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9636
Practice Address - Country:US
Practice Address - Phone:707-429-7181
Practice Address - Fax:707-429-8210
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA386842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE59323Medicare UPIN