MEDICARE: ANDREW S GOLDBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	MD-52754	IA
2	207RP1001X	Pulmonary Disease Physician	143780	MT
3	207RP1001X	Pulmonary Disease Physician	23780	OK
4	207R00000X	Internal Medicine Physician	MD-52754	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184623936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW S GOLDBERG MD

Provider Business Mailing Address
First Line	:	915 HIGHLAND BLVD
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-6902
Country	:	US
Telephone Number	:	406-414-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3905 WELLNESS WAY STE 3B
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-2402
Country	:	US
Telephone Number	:	406-414-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	04/09/2025

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