Healthcare Provider Details

I. General information

NPI: 1902809502
Provider Name (Legal Business Name): URI Z GOLDBERG D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 W HIGHWAY 20
TOLEDO OR
97391-1242
US

IV. Provider business mailing address

PO BOX 2847
CORVALLIS OR
97339-2847
US

V. Phone/Fax

Practice location:
  • Phone: 541-336-5181
  • Fax: 541-336-7614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO159256
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41999
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: