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General NPI Number Information
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NPI Number | 1841482601
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Entity Type | Organization
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Legal Business Name | MARK D GOLDBERG, MD, PC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 5252 E MAIN ST
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City | MESA
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State | AZ
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Zip | 85205-8022
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Country | US
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Telephone | 480-396-3222
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Fax | 480-396-2298
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Provider Business Mailing Address
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Address Line | 5252 E MAIN ST
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City | MESA
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State | AZ
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Zip | 85205-8022
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Country | US
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Telephone | 480-396-3222
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Fax | 480-396-2298
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Authorized Official
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Title or Position | MEDICAL DIRECTR
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Name | MARK D GOLDBERG
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Credential | MD
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Telephone | 480-396-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 18592
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License Number State | AZ
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