MEDICARE: ALBERTO GOLDGABER M D LLC

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	207R00000X	Internal Medicine Physician	33270	MO

General Provider Information

NPI Number	:	1891028023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERTO GOLDGABER M D LLC

Provider Business Mailing Address
First Line	:	11520 SAINT CHARLES ROCK RD
Second Line	:	SUITE 106
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2732
Country	:	US
Telephone Number	:	314-209-9331
Fax Number	:	314-447-0155

Provider Business Practice Location Address
First Line	:	11520 SAINT CHARLES ROCK RD
Second Line	:	SUITE 106
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2732
Country	:	US
Telephone Number	:	314-209-9331
Fax Number	:	314-447-0155

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	ALBERTO GOLDGABER
Credential	:	MD
Telephone Number	:	314-427-2425

Provider Enumeration Date	:	09/04/2009
Last Update Date	:	09/22/2009

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