Healthcare Provider Details

I. General information

NPI: 1477561942
Provider Name (Legal Business Name): ROBERT KENNETH GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

4015 SW 57TH AVE
PORTLAND OR
97221-2031
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD17264
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD17264
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: