Provider Demographics
NPI:1740291889
Name:GOLIA, JOHN KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEITH
Last Name:GOLIA
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 1:120 NE 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3801
Mailing Address - Country:US
Mailing Address - Phone:954-328-4190
Mailing Address - Fax:954-522-5593
Practice Address - Street 1:120 NE 17TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3801
Practice Address - Country:US
Practice Address - Phone:954-328-4190
Practice Address - Fax:954-522-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023884207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1238849Medicaid
B37862Medicare UPIN
050000384Medicare ID - Type Unspecified