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General NPI Number Information
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NPI Number | 1760055206
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Entity Type | Individual
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Provider Name | JEFFREY D GOLDMAN PA
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Gender | Male
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Dates
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Enumeration Date | 07/22/2021
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1901 W WILLIAM CANNON DR STE 112
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City | AUSTIN
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State | TX
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Zip | 78745-5322
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Country | US
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Telephone | 512-444-2661
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Fax | 512-444-2720
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Provider Business Mailing Address
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Address Line | 1901 W WILLIAM CANNON DR STE 112
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City | AUSTIN
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State | TX
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Zip | 78745-5322
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Country | US
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Telephone | 512-444-2661
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Fax | 512-444-2720
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA14893
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License Number State | TX
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