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General NPI Number Information
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NPI Number | 1942837414
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Entity Type | Individual
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Provider Name | ETHAN THOMAS GOLDBERG DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 3901 RAINBOW BLVD # MS 3007
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City | KANSAS CITY
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State | KS
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Zip | 66160-4720
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Country | US
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Telephone | 913-588-6045
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Fax |
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Provider Business Mailing Address
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Address Line | 232 SW DALTON CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-5846
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Country | US
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Telephone |
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 9412131
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License Number State | KS
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