Provider Demographics
NPI:1932193695
Name:GOLDNER, FRED H (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:H
Last Name:GOLDNER
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 1:8415 DATAPOINT DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3298
Mailing Address - Country:US
Mailing Address - Phone:210-614-1234
Mailing Address - Fax:210-614-7749
Practice Address - Street 1:8214 WURZBACH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3319
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-7749
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5912207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105860401Medicaid
TX88A654OtherBCBS
100005732OtherMEDICARE RAILROAD
TX105860401Medicaid
TX88A654Medicare PIN