Healthcare Provider Details

I. General information

NPI: 1790879336
Provider Name (Legal Business Name): CHARLES D GOLDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 DES MOINES ST STE 100
DES MOINES IA
50309-5507
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-4915
  • Fax: 515-643-8804
Mailing address:
  • Phone: 515-643-4915
  • Fax: 515-643-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number37356
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License NumberMD-37356
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: