Healthcare Provider Details

I. General information

NPI: 1215152723
Provider Name (Legal Business Name): JUSTIN M GOLDFARB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 N 83RD AVE UNIT 300
PEORIA AZ
85381-2004
US

IV. Provider business mailing address

15000 N 83RD AVE UNIT 300
PEORIA AZ
85381-2004
US

V. Phone/Fax

Practice location:
  • Phone: 623-238-7490
  • Fax: 480-882-5019
Mailing address:
  • Phone: 623-238-7490
  • Fax: 480-882-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-117585
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number005668
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberBP10033466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: