Healthcare Provider Details

I. General information

NPI: 1780681635
Provider Name (Legal Business Name): LAWRENCE NORMAN GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 S STATE ROAD 7 STE 100-200
WELLINGTON FL
33414
US

IV. Provider business mailing address

8953 GOLDEN MOUNTAIN CIR
BOYNTON BEACH FL
33473-3310
US

V. Phone/Fax

Practice location:
  • Phone: 561-898-5100
  • Fax: 561-898-5101
Mailing address:
  • Phone: 340-998-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberVI1128
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number87454
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME134520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: