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General NPI Number Information
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NPI Number | 1902803760
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Entity Type | Individual
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Provider Name | SANDY ROBERT GOLDMAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 17170 ROYAL PALM BLVD
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City | WESTON
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State | FL
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Zip | 33326-2339
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Country | US
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Telephone | 954-349-3376
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Fax | 954-385-8572
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Provider Business Mailing Address
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Address Line | 17170 ROYAL PALM BLVD
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City | WESTON
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State | FL
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Zip | 33326-2339
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Country | US
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Telephone | 954-349-3376
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Fax | 954-385-8572
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | SG010565
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS5360
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License Number State | FL
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