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General NPI Number Information
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NPI Number | 1093713489
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Entity Type | Individual
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Provider Name | JACOB H GOLDBERGER MD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2005
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 4571 COLONIAL BLVD SUITE 210
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City | FORT MYERS
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State | FL
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Zip | 33966-1156
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Country | US
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Telephone | 239-274-7600
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Fax | 239-274-7601
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Provider Business Mailing Address
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Address Line | 2160 COLONIAL BLVD PAYER CONTRACTING AND RELATIONS
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City | FORT MYERS
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State | FL
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Zip | 33907-1410
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Country | US
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Telephone | 239-931-7342
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Fax | 239-931-7385
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME 35410
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License Number State | FL
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