Healthcare Provider Details

I. General information

NPI: 1295261097
Provider Name (Legal Business Name): DANIEL GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 AIRPORT RD FL 6
RIFLE CO
81650-8510
US

IV. Provider business mailing address

501 AIRPORT RD
RIFLE CO
81650-8510
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-1510
  • Fax:
Mailing address:
  • Phone: 970-625-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberDR.0071514
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: