Healthcare Provider Details

I. General information

NPI: 1154317824
Provider Name (Legal Business Name): MARC S GOLDBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N 7TH ST STE 275
PHOENIX AZ
85006-2769
US

IV. Provider business mailing address

1331 N 7TH ST STE 275
PHOENIX AZ
85006-2769
US

V. Phone/Fax

Practice location:
  • Phone: 602-252-7004
  • Fax: 602-252-6232
Mailing address:
  • Phone: 602-252-7004
  • Fax: 602-252-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number10188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: